Frequency of Use and Outcomes Associated With Bronchoscopy in Pediatric Patients on ECMO

Introduction: In pediatric patients on ECMO support, some centers use flexible fiberoptic bronchoscopy to assist with airway clearance. Bronchoscopy is known to be associated with improvement in tidal volume, native oxygenation, and ECMO duration. The objectives of our study were to evaluate the association between bronchoscopy and mortality and the frequency of use of bronchoscopy in pediatric ECMO patients using a national pediatric hospital discharge database.


Methods: Data from the Kids’ Inpatient Database (KID) from 2000-2022 was used for retrospective, serial, cross-sectional analysis of patients aged 0-20 years who received ECMO support. We excluded patients with multiple runs of ECMO. Patients who underwent ECMO and bronchoscopy were identified using ICD-9 and ICD-10 procedure codes. Amongst ECMO patients, we compared demographics, diagnoses, outcomes, and complications between three groups: no bronchoscopy performed, bronchoscopy prior to ECMO cannulation, and bronchoscopy after ECMO cannulation. Our primary outcome was mortality, and secondary outcomes included the frequency of bronchoscopy before and after 2009 (H1N1 pandemic). We used the published list of common cardiac and respiratory diagnoses on the ELSO registry to stratify mortality by diagnosis. Chi-square test was used to compare categorical variables, and binary logistic regression analysis was used to examine the association between bronchoscopy and mortality while controlling for potential confounders.


Results: In a total of 14,973 patients on ECMO during the study period, 5,927 (39.5%) died. Bronchoscopy was performed in 1,365 (9.1%) patients, of whom 34.2% died. On regression analysis, compared to no bronchoscopy, the adjusted OR of mortality was 1.69 (95% CI 1.28-2.26; P< 0.001) in those who underwent bronchoscopy pre-ECMO and 0.68 (95% CI 0.59-0.78; P< 0.001) in patients who underwent bronchoscopy post-ECMO cannulation. On bronchoscopy frequency, 7.3% of ECMO patients underwent bronchoscopy prior to 2009 versus 10.0% post 2009 (P < 0.001).


Conclusions: Bronchoscopy after ECMO cannulation is associated with decreased mortality. The reasons for such an association need further exploration. There is an increased use of bronchoscopy after ECMO cannulation during and after the H1N1 pandemic.