Survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in Japan
Background: To assess the performance of pediatric extracorporeal membrane oxygenation (ECMO) centers, outcomes were compared between metropolitan and other areas. Methods: A retrospective cohort study was conducted at three regional centers on Kyushu Island and the largest center in the Tokyo metro...
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Elsevier
2025-01-01
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| Series: | Pediatrics and Neonatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957224000792 |
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| author | Noriyuki Kaku Wakato Matsuoka Kentaro Ide Takaaki Totoki Katsuki Hirai Soichi Mizuguchi Kanako Higashi Kenichi Tetsuhara Hazumu Nagata Satoshi Nakagawa Yasuyuki Kakihana Akira Shiose Shouichi Ohga |
| author_facet | Noriyuki Kaku Wakato Matsuoka Kentaro Ide Takaaki Totoki Katsuki Hirai Soichi Mizuguchi Kanako Higashi Kenichi Tetsuhara Hazumu Nagata Satoshi Nakagawa Yasuyuki Kakihana Akira Shiose Shouichi Ohga |
| author_sort | Noriyuki Kaku |
| collection | DOAJ |
| description | Background: To assess the performance of pediatric extracorporeal membrane oxygenation (ECMO) centers, outcomes were compared between metropolitan and other areas. Methods: A retrospective cohort study was conducted at three regional centers on Kyushu Island and the largest center in the Tokyo metropolitan area of Japan. The clinical outcomes of patients of ≤15 years of age who received ECMO during 2010–2019 were investigated, targeting the survival and performance at discharge from intensive care units (ICUs), using medical charts. Results: One hundred and fifty-five patients were analyzed (regional, n = 70; metropolitan, n = 85). Survival rates at ICU discharge were similar between the two areas (64%). In regional centers, deterioration of Pediatric Cerebral Performance Category (PCPC) scores were more frequent (65.7% vs. 49.4%; p = 0.042), but survival rates and ΔPCPC scores (PCPC at ICU discharge–PCPC before admission) improved in the second half of the study period (p = 0.005 and p = 0.046, respectively). Veno-arterial ECMO (odds ratio [OR], 3.00; p < 0.03), extracorporeal cardiopulmonary resuscitation (OR, 8.98; p < 0.01), and absence of myocarditis (OR, 5.47; p < 0.01) were independent risk factors for deterioration of the PCPC score. A sub-analysis of patients with acute myocarditis (n = 51), the main indicator for ECMO, revealed a significantly higher proportion of cases with deteriorated PCPC scores in regional centers (51.9% vs. 25.0%; p = 0.049). Conclusions: The survival rates of pediatric patients supported by ECMO in regional centers were similar to those in a metropolitan center. However, neurological outcomes must be improved, particularly in patients with acute myocarditis. |
| format | Article |
| id | doaj-art-ffcccdb0e1684b3495f99c7de50752aa |
| institution | Kabale University |
| issn | 1875-9572 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Pediatrics and Neonatology |
| spelling | doaj-art-ffcccdb0e1684b3495f99c7de50752aa2025-01-25T04:11:05ZengElsevierPediatrics and Neonatology1875-95722025-01-016615559Survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in JapanNoriyuki Kaku0Wakato Matsuoka1Kentaro Ide2Takaaki Totoki3Katsuki Hirai4Soichi Mizuguchi5Kanako Higashi6Kenichi Tetsuhara7Hazumu Nagata8Satoshi Nakagawa9Yasuyuki Kakihana10Akira Shiose11Shouichi Ohga12Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan; Corresponding author. Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, JapanCritical Care Medicine, National Center for Child Health and Development, Tokyo, JapanDepartment of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, JapanPediatric Intensive Care Unit, Kumamoto Red Cross Hospital, Kumamoto, JapanDepartment of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, JapanDepartment of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, JapanDepartment of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, JapanDepartment of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanCritical Care Medicine, National Center for Child Health and Development, Tokyo, JapanDepartment of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, JapanDepartment of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanBackground: To assess the performance of pediatric extracorporeal membrane oxygenation (ECMO) centers, outcomes were compared between metropolitan and other areas. Methods: A retrospective cohort study was conducted at three regional centers on Kyushu Island and the largest center in the Tokyo metropolitan area of Japan. The clinical outcomes of patients of ≤15 years of age who received ECMO during 2010–2019 were investigated, targeting the survival and performance at discharge from intensive care units (ICUs), using medical charts. Results: One hundred and fifty-five patients were analyzed (regional, n = 70; metropolitan, n = 85). Survival rates at ICU discharge were similar between the two areas (64%). In regional centers, deterioration of Pediatric Cerebral Performance Category (PCPC) scores were more frequent (65.7% vs. 49.4%; p = 0.042), but survival rates and ΔPCPC scores (PCPC at ICU discharge–PCPC before admission) improved in the second half of the study period (p = 0.005 and p = 0.046, respectively). Veno-arterial ECMO (odds ratio [OR], 3.00; p < 0.03), extracorporeal cardiopulmonary resuscitation (OR, 8.98; p < 0.01), and absence of myocarditis (OR, 5.47; p < 0.01) were independent risk factors for deterioration of the PCPC score. A sub-analysis of patients with acute myocarditis (n = 51), the main indicator for ECMO, revealed a significantly higher proportion of cases with deteriorated PCPC scores in regional centers (51.9% vs. 25.0%; p = 0.049). Conclusions: The survival rates of pediatric patients supported by ECMO in regional centers were similar to those in a metropolitan center. However, neurological outcomes must be improved, particularly in patients with acute myocarditis.http://www.sciencedirect.com/science/article/pii/S1875957224000792ChildrenECMOOutcomeMyocarditisRegional difference |
| spellingShingle | Noriyuki Kaku Wakato Matsuoka Kentaro Ide Takaaki Totoki Katsuki Hirai Soichi Mizuguchi Kanako Higashi Kenichi Tetsuhara Hazumu Nagata Satoshi Nakagawa Yasuyuki Kakihana Akira Shiose Shouichi Ohga Survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in Japan Pediatrics and Neonatology Children ECMO Outcome Myocarditis Regional difference |
| title | Survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in Japan |
| title_full | Survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in Japan |
| title_fullStr | Survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in Japan |
| title_full_unstemmed | Survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in Japan |
| title_short | Survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in Japan |
| title_sort | survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in japan |
| topic | Children ECMO Outcome Myocarditis Regional difference |
| url | http://www.sciencedirect.com/science/article/pii/S1875957224000792 |
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