Extracorporeal albumin dialysis in paediatric patients with sepsis and multiorgan dysfunction

Introduction

Extracorporeal membrane oxygenation (ECMO) is used in managing paediatric patients with severe cardiorespiratory dysfunction refractory to conventional treatments. The survival in such patients is reported to be between 45% and 70%. However, the survival of paediatric patients on ECMO with multiorgan dysfunction in the setting of sepsis is very low, with a reported mortality of 100%. We report a series of five paediatric patients with sepsis and multiorgan dysfunction who were managed by extra-corporeal albumin dialysis (EAD) during their course on ECMO.

Patients and methods

All paediatric patients with sepsis-induced multiorgan dysfunction who were treated in our unit with ECMO and EAD were included. Patients who were treated with EAD mainly for high bilirubin in the absence of evidence of severe sepsis were excluded. All patients fulfilled the criteria for severe sepsis as suggested by the ACCP/SCCM Consensus Conference Committee. EAD was performed using a molecular adsorbent recirculating system (Gambro AB, Stockholm, Sweden).

Results

The age of the patients ranged between 1 month and 17 years. The primary diagnosis was pneumonia in four patients (bacterial in three patients and viral in one patient) and meningo-coccal septicaemia in one patient. All patients had positive bacterial cultures and two patients also had positive viral serology at the time of admission for ECMO. All patients had cardiac and respiratory dysfunction at the time of admission for ECMO. In addition two patients had renal dysfunction and one patient each had hepatic and haematological dysfunction at the time of admission for ECMO. All these patients deteriorated subsequently and EAD was used as rescue therapy. At the time of institution of EAD four patients had dysfunction of four organs (respiratory, cardiac, renal and liver) and one patient had dysfunction of five organs (respiratory, cardiac, renal, liver and haematological dysfunction). All patients received between one and three EAD treatments. Two out of the five patients (40%) survived to hospital discharge. All these patients would have been expected to die according to our previous experience as well as the published results in such a group of patients.

Conclusion

EAD may prove to be an effective treatment in paediatric patients with sepsis-induced multiorgan dysfunction. Further research is required to identify the group of patients who would benefit most from the use of EAD in the setting of sepsis-induced multiorgan dysfunction.