Treatment of children with arcs transferred for ecmo wtth surfactant and nitric oxide -a pilot study m 23 patents

ECMO is an effective therapy in severe pédiatrie ARDS (1). We could demonstrate earlier that surfactant improves oxygénation in some patients with severe AROS (pa02/FiO2 ratio <100). A beneficial effect of NO has been documented in neonates and adults (3,4). Based on these results we elaborated an algorithm for AROS patients beyond newborn age. METHODS: Children with AROS transferred for ECMO were treated immediately with ECMO if the paO2 was < 40 for 2 hrs. In all other children ventilated with an FiO2 of 1.0 for at least 72 hrs. were treated according to the following algorithm ALGOMTHM: PrteM ummlmita to ECHO I > 38 to IMM 72 hr ) tf 10, < 4= ECMO odwr pMfcra lot 2In. Option in ventillatin and nonffnxmmn' 91-23) = piun.anM iiriiriliiuli = HO 1-2O MOT D-41 => Mmjnjm >MMec => 100mlk ivtectM M-1t no mpraxHMm (Air 4 hn. => ECMO ta-2) RESULTS: Of 23 patients 2 died despite ECMO, S without ECMO (contrain dications). Nitric oxide either alone or in combination did not alter the paO2. FiO2 ratio significantly. The mean paO3/FKD2 ratio before increased 4 hrs. after surfactant application from 58.3 (±26) to 111.53 (±56) and 164.3 (±120) after 48 hrs. It was sustained in all patients (in five non-survivors life support was withdrawn because of irreversible organ failure). One child survived with severe brain damage (near drowning). All other patients were discharged home (mean days on ventilator 9,5, range 1-21 days) without oxygen therapy. CONCLUSION: Surfactant improves oxygénation in children with severe AROS, nitric oxide in our study did not. Due to the underlying disease (MODS, irreversible diseases, severe brain injury) we could not observe a decrease in mortality compared to own historical controls of 26% (5) A controlled clinical international study is warranted and has been Started. REFERENCES: 1. SM Oonn: Dm Physiopnh nd Clin 3:235-241,1992:2. J.C.Möller et al Int J Anif Organs 18:598-602.1995:3.Cwffi and Ogura New Horuons 373 85.1995:4.Finer at al. J PcdMtr 124:302-308.1994:5. JC Möller et al. AnMstne 41:399 402.1994.