S. Tam1, A. Mobargha2, J. Tobias3, C. Schad4, S. Okochi1, A. Shakoor1, W. Middlesworth1, V. Duron1 1New York Presbyterian Hospital,New York, NY, USA 2Copenhagen University Hospital,Copenhagen, -, Denmark 3Columbia University College Of Physicians And Surgeons,New York, NY, USA 4Morgan Stanley Children’s Hospital of New York,New York, NY, USA
Introduction:
Critically ill pediatric patients have been shown to be at risk for pressure ulcers similar to adult patients. Associated with this are increased morbidity and length of stay, decreased quality of life, and increased hospital costs. While the incidence of pressure ulcers in patients in pediatric intensive care unit patients has been studied, there are virtually no studies addressing pressure ulcers in pediatric patients on extracorporeal membraneous oxygenation (ECMO).
Methods:
The charts of patients 21 years and younger who underwent ECMO from November 2009 to November 2015 at our Tertiary Care Children’s Hospital were analyzed. All patients developed a pressure ulcer either during their ECMO run or within 7 days of decannulation according to nursing documentation. All data was collected and de-identified from the institution’s electronic medical record. Variables of interest included type of ECMO – venovenous (VV) or venoarterial (VA), amount volume of crystalloid and blood products received during the first 7 days or during the length of the ECMO run, albumin and lactate levels on the day of ulcer formation, and whether patients were on vasopressor supportreceived steroids.
Results:
From November 2009 to November 2015, 204 patients were placed on ECMO and 10% (20) developed a pressure ulcer during their ECMO run or within 7 days of decannulation. The average age of patients was 110 ± 86 months and 60% were male. The average body surface area was 1.1 ± 0.8 m2. Most patients were placed on venoarterial (VA) ECMO (85%) and the average length of the ECMO run was 460 ± 360 hours. A majority of the decubitus ulcers were stage I (40%) and stage II (35%). Patients received a mean of 4337 ± 2609 mL of crystalloid and 4337 ± 4727 mL of blood products during the first 7 days of their ECMO run. Mean albumin on the day of ulcer formation was 3.3 ± 0.5 g/dL and lactate was 1.1 ± 0.5 mmol/L. A majority of patients were on vasopressor support during their ECMO run (70%).
Conclusion:
This is the only observational study to date evaluating pressure ulcer formation in pediatric patients receiving ECMO. These patients are at risk of pressure ulcer formation due to their prolonged immobility and critical illness. This baseline analysis emphasizes the need for further studies identifying which risk factors are associated with ulcer development in pediatric patients on ECMO.