scholarly journals Peripheral Extracorporeal Membrane Oxygenation is a safe and effective support modality for pediatric patients with sepsis

2020 ◽  
Vol 3 ◽  
Author(s):  
Brielle Warnock ◽  
Joshua Brown ◽  
Eamaan Turk ◽  
Gail Hocutt ◽  
Brian Gray
Keyword(s):  
Septic Shock ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Serum Lactate ◽  
Ecmo Support ◽  
Bleeding Complications ◽  
Flow Rates ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Septic Group

Background  Extracorporeal Membrane Oxygenation (ECMO) can be used as a treatment modality for pediatric patients with refractory septic shock. Previous studies indicate central ECMO, with direct cardiac cannulation, is superior for septic patients. At Riley Hospital for Children, we believe that peripheral ECMO support, through cervical or femoral vessels, is an effective and safe method of supporting pediatric septic patients in a less invasive manner.    Methods  We reviewed pediatric (30 days to 18 years) patients supported with ECMO for septic shock from 2005-2019 at Riley Hospital for Children and compared them to non-septic respiratory failure patients supported with ECMO. Pre-ECMO data points, demographics, cannulation sites, flow rates, lab values, Vasoactive Ionotropic Score(VIS), P-Prep score, and outcomes were collected and analyzed using t-test and multivariate analyses. We defined a significance as p=0.05.   Results  35 of 80 ECMO patients were supported for septic shock. Septic patients were larger (25.1kg vs 11.4kg, p=0.005) and older (85.6 vs 18.8 months, p=0.001). Pre-ECMO VIS and P-Prep were both greater in the septic group (p=0.007 and p<0.001). Pre-ECMO serum lactate level was higher in the septic group (3.7 vs 1.4, p=0.012) , but by 96hrs, lactate normalized in both groups. Flow rates at 24 hours were similar between the two groups (91mL/kg/min vs 88mL/kg/min, p=0.079). No significant difference in bleeding complications or blood product administration was found, but there was a higher incidence of renal failure in septic patients. Survival in the septic group was similar to the comparison group (51.4% vs 62.2%, p-0.37). Hours on ECMO and length of stay were also similar.   Conclusion and Potential Impact  Despite septic patients appearing more ill prior to ECMO, they had similar mortality, support parameters, and outcomes, showing that septic shock is not a contraindication to peripheral ECMO support in pediatric patients.  

scholarly journals Association of Fluid Balance and Survival of Pediatric Patients Treated With Extracorporeal Membrane Oxygenation

2021 ◽  
Vol 9 ◽  
Author(s):  
Prakadeshwari Rajapreyar ◽  
Lauren Castaneda ◽  
Nathan E. Thompson ◽  
Tara L. Petersen ◽  
Sheila J. Hanson
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
Fluid Balance ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Pediatric Intensive Care ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Outcome Performance

The effect of positive fluid balance (FB) on extracorporeal membrane oxygenation (ECMO) outcomes in pediatric patients remains unknown. We sought to evaluate if positive FB in pediatric intensive care unit (PICU) patients with respiratory and/or cardiac failure necessitating ECMO was associated with increased morbidity or mortality. This was a multicenter retrospective cohort study of data from the deidentified PEDiatric ECMO Outcomes Registry (PEDECOR). Patients entered into the database from 2014 to 2017, who received ECMO support, were included. A total of 168 subjects met the study criteria. Univariate analysis showed no significant difference in total FB on ECMO days 1–5 between survivors and non-survivors [median 90 ml/kg (IQR 18–208.5) for survivors vs. median 139.7 ml/kg (IQR 11.2–300.6) for non-survivors, p = 0.334]. There was also no difference in total FB on ECMO days 1–5 in patients with no change in functional outcome as reflected by the Pediatric Outcome Performance Category (POPC) score vs. those who had worsening in POPC score ≥2 at hospital discharge [median 98 ml/kg (IQR 18–267) vs. median 130 ml/kg (IQR 13–252), p = 0.91]. Subjects that required 50 ml/kg or more of blood products over the initial 5 days of ECMO support had an increased rate of mortality with an odds ratio of 5.8 (95% confidence interval of 2.7–12.3; p = 0.048). Our study showed no association of the noted FB with survival after ECMO cannulation. This FB trend was also not associated with POPC at hospital discharge, MV duration, or ECMO duration. The amount of blood product administered was found to be a significant predictor of mortality.

scholarly journals Outcomes of Pediatric Patients with Abdominal Sepsis Requiring Surgery and Extracorporeal Membrane Oxygenation Using the Extracorporeal Life Support Organization Database

2015 ◽  
Vol 81 (3) ◽  
pp. 245-251 ◽  
Author(s):  
Michael R. Phillips ◽  
Amal L. Khoury ◽  
Briana J. K. Stephenson ◽  
Lloyd J. Edwards ◽  
Anthony G. Charles ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Abdominal Sepsis ◽  
Bleeding Complications ◽  
Extracorporeal Life Support Organization ◽  
Membrane Oxygenation ◽  
Support Organization

No study describes the use of extracorporeal membrane oxygenation (ECMO) in pediatric patients with abdominal sepsis (AS) requiring surgery. A description of outcomes in this patient population would assist clinical decision-making and provide a context for discussions with patients and families. The Extracorporeal Life Support Organization database was queried for pediatric patients (30 days to 18 years) with AS requiring surgery. Forty-five of 61 patients survived (73.8%). Reported bleeding complications (57.1 vs 48.8%), the number of pre-ECMO ventilator hours (208.1 vs 178.9), and the timing of surgery before (50 vs 66.7%) and on-ECMO (50 vs 26.7%) were similar in survivors and nonsurvivors. Decreased pre-ECMO mean pH (7.1 vs 7.3) was associated with increased mortality (odds ratio, 1.49; 95% confidence interval, 1.04 to 2.14). ECMO use for pediatric patients with AS requiring surgery is associated with increased mortality and an increased rate of bleeding complications compared with all pediatric patients receiving ECMO support. Acidemia predicts mortality and provides a potential target of examination for future studies.

Extracorporeal Membrane Oxygenation in Postcardiotomy Pediatric Patients—15 Years of Experience Outside Europe and North America

2017 ◽  
Vol 67 (01) ◽  
pp. 028-036 ◽  
Author(s):  
Mohamed Ismail ◽  
Tamer Hamouda ◽  
Rafik Shaikh ◽  
Alaa Mahmoud ◽  
Mohammad Shihata ◽  
...  
Keyword(s):  
Renal Failure ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Ecmo Support ◽  
Hospital Death ◽  
Congenital Cardiac Surgery ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support

Background The increasing complexity of congenital cardiac surgery has resulted in the increased use of extracorporeal membrane oxygenation (ECMO) support for children who cannot be weaned from cardiopulmonary bypass. The purpose of this research was to assess the mortality and morbidity in children requiring ECMO support after the repair of congenital heart defects (CHDs). Methods The hospital records of all patients with CHD who required ECMO after a cardiac surgical procedure between January 2001 and December 2016 were retrospectively reviewed. Various outcomes were reported and tested for any association with hospital death. Results A total of 113 children required ECMO for cardiopulmonary support after congenital cardiac surgery; 88 (77.9%) were placed on ECMO in the operating room. Median age of the patients was 3 months (range, 4 days–15 years) and median weight was 3.5 kg (range, 2.2–42.5). Forty-two (37.2%) survived to hospital discharge. In children with single-ventricle physiology, survival to discharge was 37.3% (19/51 patients) and for biventricular physiology, it was 37.1% (23/62 patients). Univariate analysis revealed number of days on ECMO support, renal failure, and stroke as risk factors for hospital mortality, while age and cross-clamp time were found to be statistically nonsignificant. Conclusion Satisfactory results can be achieved in pediatric patients by using ECMO support for postoperative cardiac and pulmonary failure refractory to medical management. Prolonged ECMO support, renal failure, and stroke are risk of mortality.

scholarly journals Stroke During Extracorporeal Membrane Oxygenation: Timing, Risk Factors and Clinical Outcomes

2021 ◽  
Author(s):  
Harim Kim ◽  
Jeong Hoon Yang ◽  
Chi Ryang Chung ◽  
Kyeongman Jeon ◽  
Gee Young Suh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Brain Injuries ◽  
Medical Center ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Stroke Group ◽  
Va Ecmo ◽  
Vv Ecmo

Abstract Background Among various complications of extracorporeal membrane oxygenation (ECMO), stroke continues to be a major factor that worsens the clinical outcome because it is associated with mortality and adverse neurologic outcomes. Appropriate risk evaluation, screening, and management of neurologic injury under ECMO support has not yet been established and requires further investigation. Thus, this study analyzes the stroke related risk factors and outcomes in order to determine the appropriate intervention to minimize neurologic sequalae while on ECMO. Method Total 1039 patients who underwent ECMO from January 2012 to September 2019 at the Samsung Medical Center were reviewed and 759 subjects were selected for the analysis. The exclusion criteria were age < 18y, failure of successful ECMO initiation, multiple ECMO runs, underlying severe brain injury, and incomplete medical records. Multivariate analysis was performed to identify the risk factors of strokes on ECMO support using cox proportional hazard regression. In order to analyze the timing of stroke after ECMO initiation, the Mann–Whitney U test and Kruskal–Wallis rank sum test were performed.Results Among The overall incidence of stroke was 5.1% (n = 39) without a significant difference between venoarterial (VA) and venovenous(VV) ECMO (5.3% and 4.8%, respectively, p = 0.480). Independent risk factors for stroke were intraaortic balloon pump (IABP, p = 0.0008) and a history of stroke (p = 0.0354). Most hypoxic brain injuries were found in the VA ECMO (93.3%), and 54.5% of intracranial hemorrhage were in the VV ECMO. Most patients with strokes (61.5%) were diagnosed within 72hours after ECMO initiation. The time taken for stroke event from the time of ECMO insertion was shorter in the VA ECMO than in the VV ECMO (median 1.5 vs. 3 days). The stroke group had a higher mortality rate than the non-stroke group (64.1% and 44.7%, respectively, p = 0.014). Conclusion Concurrent ECMO and IABP use may increase the incidence of stroke during ECMO support. Evaluation for stroke that includes CT within 72 hours of ECMO insertion may enable early diagnosis, allowing timely intervention.

scholarly journals Volumetric Capnography in Pediatric Extracorporeal Membrane Oxygenation: A Case Series

2020 ◽  
Author(s):  
Kim R. Derespina ◽  
Shivanand S. Medar ◽  
Scott I. Aydin ◽  
Shubhi Kaushik ◽  
Awni Al-Subu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Case Series ◽  
Blood Gases ◽  
Ecmo Support ◽  
Optimal Timing ◽  
Hemodynamic Stability ◽  
Volumetric Capnography ◽  
Patient Demographics ◽  
Membrane Oxygenation

AbstractThe kinetics of carbon dioxide elimination (VCO2) may be used as a surrogate for pulmonary blood flow. As such, we can apply a novel use of volumetric capnography to assess hemodynamic stability in patients requiring extracorporeal membrane oxygenation (ECMO). We report our experience of pediatric patients requiring ECMO support who were monitored using volumetric capnography. We describe the use of VCO2 and its association with successful decannulation. This is a prospective observational study of pediatric patients requiring ECMO support at The Children's Hospital at Montefiore from 2017 to 2019. A Respironics NM3 monitor was applied to each patient. Demographics, hemodynamic data, blood gases, and VCO2 (mL/min) data were collected. Data were collected immediately prior to and after decannulation. Over the course of the study period, seven patients were included. Predecannulation VCO2 was higher among patients who were successfully decannulated than nonsurvivors (109 [35, 230] vs. 12.4 [7.6, 17.2] mL/min), though not statistically significant. Four patients (57%) survived without further mechanical support; two (29%) died, and one (14%) was decannulated to Berlin. Predecannulation VCO2 appears to correlate with hemodynamic stability following decannulation. This case series adds to the growing literature describing the use of volumetric capnography in critical care medicine, particularly pediatric patients requiring ECMO. Prospective studies are needed to further elucidate the use of volumetric capnography and optimal timing for ECMO decannulation.

Predictors of Poor Outcomes in Pediatric Venoarterial Extracorporeal Membrane Oxygenation

2018 ◽  
Vol 9 (3) ◽  
pp. 297-304 ◽  
Author(s):  
Maanasi S. Mistry ◽  
Sara M. Trucco ◽  
Timothy Maul ◽  
Mahesh S. Sharma ◽  
Li Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Ecmo Support ◽  
Cardiorespiratory Failure ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Poor Outcomes ◽  
Va Ecmo ◽  
Elevated Lactate

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides respiratory and hemodynamic support to pediatric patients in severe cardiac failure. We aim to identify risk factors associated with poorer outcomes in this population. Methods: A retrospective chart review was conducted of pediatric patients requiring VA-ECMO support for cardiac indications at our institution from 2004 to 2015. Data were collected on demographics, indication, markers of cardiac output, ventricular assist device (VAD) insertion, heart transplantation, or left atrial (LA) decompression. Univariate Cox proportional hazards models were used to calculate hazard ratios (HRs) for variables associated with the composite primary outcome of transplant-free survival (TFS). Results: Of the 68 reviewed patients, 65% were male, 84% were white, 38% had a prior surgery, 13% had a prior transplant, 10% had a prior ECMO support, and 87.5% required vasoactive support within six hours of cannulation. The ECMO indications included congenital heart disease repaired >30 days prior (12%), cardiomyopathy (41%), posttransplant rejection (7%), and cardiorespiratory failure (40%). The TFS was 54.5% at discharge and 47.7% at one year. Predictors of transplant and/or death include epinephrine use (hazard ratio [HR] = 2.269, P = .041), elevated lactate (HR = 1.081, P = 0005), and elevated creatinine (HR = 1.081, P = .005) within six hours prior to cannulation. Sixteen (23.6%) patients underwent LA decompression. Placement of VAD occurred in 16 (23.5%) patients, for which nonwhite race (HR = 2.94, P = .034) and prior ECMO (HR = 3.42, P = .053) were the only identified risk factors. Conclusions: Need for VA-ECMO for cardiac support carries high inpatient morbidity and mortality. Epinephrine use and elevated lactate and creatinine were associated with especially poor outcomes. Patients who survived to discharge had good short-term follow-up results.

scholarly journals Clinical Characteristics Between Survivors and Nonsurvivors of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 088506662110456
Author(s):  
Woon Hean Chong ◽  
Biplab K. Saha ◽  
Boris I. Medarov
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Clinical Characteristics ◽  
Meta Analysis ◽  
Plateau Pressure ◽  
Ecmo Support ◽  
Bleeding Complications ◽  
Membrane Oxygenation ◽  
Global Pandemic ◽  
Secondary Infections ◽  
Study Results

Background: The use of extracorporeal membrane oxygenation (ECMO) in coronavirus disease 2019 (COVID-19) for refractory respiratory failure, severe cardiac dysfunction, and bridge to lung transplantation has been steadily increasing during the ongoing global pandemic. Objective: Our meta-analysis aims to compare the clinical characteristics between COVID-19 survivors and nonsurvivors requiring ECMO support. Methods: A systematic search of Pubmed, Cochrane, Embase, Scopus, and Web of Science databases was performed between December first, 2019, to June first, 2021. Studies with comparative data of COVID-19 ECMO patients were selected, in which clinical characteristics and complications were assessed. Results: Sixteen cohort studies involving 706 COVID-19 patients requiring ECMO support with pooled mortality rate of 40% were included. Younger age (mean 51 years vs 55 years; P < .001), fewer comorbidities (23% vs 31%; odds ratio [OR] 0.55; P  =  .02), and less renal replacement therapy (RRT) (21% vs 39%; OR 0.41; P  =  .007) and vasopressor (76% vs 92%; OR 0.35; P  =  .008) requirement were demonstrated in COVID-19 survivors requiring ECMO support than nonsurvivors. Survivors also had higher pre-ECMO pH (mean 7.33 vs 7.26; P < .001) than nonsurvivors. No difference was observed in gender, body mass index, duration of mechanical ventilation (MV) before ECMO support initiation, total ECMO support duration, and pre-ECMO parameters of PaO2/FiO2 ratio, tidal volume (mL/kg), positive end-expiratory pressure, and plateau pressure. The rate of bleeding complications was lower in survivors (32% vs 59%; OR 0.36; P  =  .001) than nonsurvivors, but no difference was observed in thromboembolism and secondary infections. Conclusions: We found advanced age, multiple comorbidities, lower pre-ECMO pH, greater RRT, and vasopressor requirements, and bleeding are predictors of death in COVID-19 patients requiring ECMO support. The duration of MV before ECMO support initiation and total ECMO support duration was similar among survivors and nonsurvivors. Our study results have important clinical implications when considering ECMO support in critically ill COVID-19 patients.

Thromboembolic Events in Patients on Extracorporeal Membrane Oxygenation without Anticoagulation

2010 ◽  
Vol 5 (6) ◽  
pp. 424-429 ◽  
Author(s):  
Yoan Lamarche ◽  
Bryan Chow ◽  
Annie Bédard ◽  
Navreet Johal ◽  
Annemarie Kaan ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Limb Ischemia ◽  
Ecmo Support ◽  
Interquartile Range ◽  
Bleeding Complications ◽  
Cerebrovascular Event ◽  
Membrane Oxygenator ◽  
Membrane Oxygenation ◽  
Systemic Anticoagulation ◽  
Va Ecmo

Objective Heparinization is thought to be mandatory to avoid thromboembolic complications during venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, bleeding complications are common. We report our experience of VA-ECMO without systemic anticoagulation. Methods A prospectively assembled database describing all ECMO cases from 2000 to 2008 was analyzed. A heparin coated circuit (Medtronic, Inc., Minneapolis, MN USA) and membrane oxygenator (Quadrox D Bioline oxygenator; MAQUET, Rastatt, Germany) were used in all cases. After the initiation of VA-ECMO support, all coagulation parameters were corrected. No further systemic maintenance anticoagulant was given, except at the time of weaning. Results Thirty-two patients received VA-ECMO support; 20 patients (62.5%) were males with a median age of 52.5 years (interquartile range, 40.4–61.1 years). Central and peripheral cannulations were 53% and 47%, respectively. Etiologies of cardiogenic shock were postcardiotomy (75%, n = 24) and as a support to cardiopulmonary resuscitation in 25% of cases (n = 8). Thirty-day mortality was 43.8%. Median duration of ECMO support was 46.3 hours (interquartile range, 26.8–87.8 hours). The median number of packed red blood cell transfusions was 18 ± 25. Complications include five patients (16%) with limb ischemia requiring intervention, 15 patients (46.9%) had acute renal failure, two patients had deep vein thrombosis, and two patients had intracardiac clots detected on echocardiograms. No patient had a cerebrovascular event. Incidence of membrane oxygenator failure was low, requiring replacement in three patients; no adverse event occurred during replacement. Fourteen patients (43.8%) were re-explored for bleeding. Fourteen patients (44%) were discharged home and were long-term survivors. Conclusions VA-ECMO support without systemic anticoagulation may reduce bleeding complications and transfusion requirement, without increasing the risk of thromboembolism.

Use of flexible bronchoscopy in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support

2011 ◽  
Vol 46 (11) ◽  
pp. 1108-1113 ◽  
Author(s):  
Pradip P. Kamat ◽  
Jonathan Popler ◽  
Joel Davis ◽  
Traci Leong ◽  
Sarah C. Piland ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Ecmo Support ◽  
Flexible Bronchoscopy ◽  
Membrane Oxygenation
Sign in / Sign up

Export Citation Format

Share Document