P0464 - Extracorporeal Membrane Oxygenation (ECMO) support for near fatal asthma

Background: Approximately 6 million children in the United States have asthma; more than half of those children will have an asthma attack at least once a year. In 2017, 185 children died secondary to their asthma (7). Near fatal asthma is a life-threatening condition of acute respiratory failure and the most severe clinical presentation of status asthmaticus. In addition to first line therapies, it often requires mechanical ventilation, inhaled volatile anesthetics, and paralysis with neuromuscular blockade (2,5,6). The use of extracorporeal membrane oxygenation (ECMO) support has been described for near fatal asthma that continues to have hypercapnic respiratory acidosis despite maximal medical therapy (1,3, 4, 8).

Objective: To describe demographics, medications, ventilation and ECMO parameters in children with near fatal asthma supported on ECMO. To identify differences in outcomes and medical management in patients who receive ECMO vs isoflurane alone for the management of their near fatal asthma.

Methods: Children ages 0-18 admitted to the pediatric intensive care unit from 2012- 2019 with the diagnosis of asthma who were intubated and supported on ECMO or given inhaled volatile anesthetics were included. Any child with comorbidities such as immunosuppression or underlying genetic conditions were excluded. Data was collected by chart review of EMR. Statistical analyses were carried out using JMP®. Fisher’s exact or Pearson’s chi-square were used to look for associations between categorical variables, Wilcoxon-Mann-Whitney test was used to compare non-normally distributed continuous variables, and logistic regression was used to compare categorical to continuous variables. Statistical significance was defined as a p-value <0.05.

Results: A total of 17 children were selected (ages 1-18). Patients were divided into either the case group (VV- ECMO, n= 9) or the control group (isoflurane only, n=8). Data analysis is ongoing. Preliminary results show a 100% survival rate of patients in both groups. Median ECMO course was 55 hours. Three patients in the ECMO cohort developed complications but these resolved at time of discharge

Conclusion: ECMO is a reasonable support therapy for near fatal asthma and providers should feel comfortable in considering it when appropriate for their patient.