scholarly journals Extracorporeal Life Support in Pediatric Patients with Bronchopulmonary Dysplasia and Associated Pulmonary Hypertension

ASAIO Journal ◽  
2020 ◽  
Vol 66 (9) ◽  
pp. 1063-1067
Author(s):  
Alejandra Pena Hernandez ◽  
Nicholas R. Carr ◽  
Donald McCurnin ◽  
Veronica Armijo-Garcia
Keyword(s):  
Pulmonary Hypertension ◽  
Bronchopulmonary Dysplasia ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support

Extracorporeal membrane oxygenation outcomes in children with hemophagocytic lymphohistiocytosis

Perfusion ◽  
2016 ◽  
Vol 32 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Katherine Cashen ◽  
Roland L Chu ◽  
Justin Klein ◽  
Peter T Rycus ◽  
John M Costello
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Failure ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Hemorrhagic Complication ◽  
Membrane Oxygenation ◽  
Va Ecmo

Introduction: Pediatric patients with hemophagocytic lymphohistiocytosis (HLH) may develop refractory respiratory or cardiac failure that warrants consideration for extracorporeal membrane oxygenation (ECMO) support. The purposes of this study were to describe the use and outcomes of ECMO in pediatric HLH patients, to identify risk factors for hospital mortality and to compare their ECMO use and outcomes to the ECMO population as a whole. Methods: Pediatric patients (⩽ 18 years) with a diagnosis of HLH in the Extracorporeal Life Support Organization (ELSO) Registry were included. Results: Between 1983 and 2014, data for 30 children with HLH were available in the ELSO registry and all were included in this study. All cases occurred in the last decade. Of the 30 HLH patients, 24 (80%) had a respiratory indication for ECMO and six (20%) had a cardiac indication (of which 4 were E-CPR and 2 cardiac failure). Of the 24 respiratory ECMO patients, 63% were placed on VA ECMO. Compared with all pediatric patients in the ELSO registry during the study period (n=17,007), HLH patients had worse hospital survival (non-HLH 59% vs HLH 30%, p=0.001). In pediatric HLH patients, no pre-ECMO risk factors for mortality were identified. The development of a hemorrhagic complication on ECMO was associated with decreased mortality (p=0.01). Comparing HLH patients with respiratory failure to patients with other immune compromised conditions, the overall survival rate is similar (HLH 38% vs. non-HLH immune compromised 31%, p=0.64). Conclusions: HLH is an uncommon indication for ECMO and these patients have increased mortality compared to the overall pediatric ECMO population. These data should be factored into decision-making when considering ECMO for pediatric HLH patients.

scholarly journals Extracorporeal Membrane Oxygenation: The First 10 Years Experience of a Portuguese Pediatric Intensive Care Unit

2021 ◽  
Vol 34 (6) ◽  
pp. 435
Author(s):  
Daniel Meireles ◽  
Francisco Abecasis ◽  
Leonor Boto ◽  
Cristina Camilo ◽  
Miguel Abecasis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Overall Survival ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Pediatric Intensive Care ◽  
Overall Survival Rate ◽  
Clinical Complications

Introduction: In Portugal, extracorporeal membrane oxygenation (ECMO) is used in pediatric patients since 2010. The aim of this study was to describe the clinical characteristics of patients, indications, complications and mortality associated with the use of ECMO during the first 10-years of experience in the Pediatric Intensive Care Unit located in Centro Hospitalar Universitário Lisboa Norte.Material and Methods: Retrospective observational cohort study of all patients supported with ECMO in a Pediatric Intensive Care Unit, from the 1st of May 2010 up to 31st December 2019.Results: Sixty-five patients were included: 37 neonatal (≤ 28 days of age) and 28 pediatric patients (> 28 days). In neonatal cases, congenital diaphragmatic hernia was the main reason for ECMO (40% of neonatal patients and 23% of total). Among pediatric patients, respiratory distress was the leading indication for ECMO (47% of total). The median length of ECMO support was 12 days. Clinical complications were more frequent than mechanical complications (65% vs 35%). Among clinical complications, access site bleeding was the most prevalent with 38% of cases. The overall patient survival was 68% at the time of discharge (65% for neonatal and 71% for pediatric cases), while the overall survival rate in Extracorporeal Life Support Organization registry was 61%. The number of ECMO runs has been increasing since 2011, even though in a non-linear way (three cases in 2010 to 11 cases in 2019).Discussion: In the first 10 years we received patients from all over the country. Despite continuous technological developments, circuitrelated complications have a significant impact. The overall survival rate in the Pediatric Intensive Care Unit was not inferior to the one reported by the Extracorporeal Life Support Organization.Conclusion: The overall survival of our Pediatric Intensive Care Unit is not inferior to one reported by other international centers. Our experience showed the efficacy of the ECMO technique in a Portuguese centre.

scholarly journals Veno-Arterial Extracorporeal Life Support (ECLS) After Bilateral Lung and Heart-Lung Transplantations for Pulmonary Hypertension

2016 ◽  
Vol 35 (4) ◽  
pp. S371-S372
Author(s):  
T. Kortchinsky ◽  
S. Mussot ◽  
S. Rezaiguia-Delclaux ◽  
M. Artiguenave ◽  
E. Fadel ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Bilateral Lung

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.

Nurse-driven analgesia and sedation in pediatric patients with univentricular hearts requiring extracorporeal life support after first-stage palliation surgery: A pilot study

2017 ◽  
Vol 27 (12) ◽  
pp. 1261-1270 ◽  
Author(s):  
Jörg Michel ◽  
Michael Hofbeck ◽  
Ines Gerbig ◽  
Vanya Icheva ◽  
Ellen Heimberg ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support

External validation of the Pediatric Extracorporeal Membrane Oxygenation Prediction model for risk adjusting mortality

Perfusion ◽  
2020 ◽  
pp. 026765912095297
Author(s):  
David K Bailly ◽  
Jamie M Furlong-Dillard ◽  
Melissa Winder ◽  
Mark Lavering ◽  
Ryan P Barbaro ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Prediction Model ◽  
Goodness Of Fit ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Characteristic Curve ◽  
External Validation ◽  
Group Model ◽  
Membrane Oxygenation

Introduction: The Pediatric Extracorporeal Membrane Oxygenation Prediction (PEP) model was created to provide risk stratification for all pediatric patients requiring extracorporeal life support (ECLS). Our purpose was to externally validate the model using contemporaneous cases submitted to the Extracorporeal Life Support Organization (ELSO) registry. Methods: This multicenter, retrospective analysis included pediatric patients (<19 years) during their initial ECLS run for all indications between January 2012 and September 2014. Median values from the BATE dataset for activated partial thromboplastin time and internationalized normalized ratio were used as surrogates as these were missing in the ELSO group. Model discrimination was evaluated using area under the receiver operating characteristic curve (AUC), and goodness-of-fit was evaluated using the Hosmer-Lemeshow test. Results: A total of 4,342 patients in the ELSO registry were compared to 514 subjects from the bleeding and thrombosis on extracorporeal membrane oxygenation (BATE) dataset used to develop the PEP model. Overall mortality was similar (42% ELSO vs. 45% BATE). The c-statistic after external validation decreased from 0.75 to 0.64 and model calibration decreases most in the highest risk deciles. Conclusion: Discrimination of the PEP model remains modest after external validation using the largest pediatric ECLS cohort. While the model overestimates mortality for the highest risk patients, it remains the only prediction model applicable to both neonates and pediatric patients who require ECLS for any indication and thus maintains potential for application in research and quality benchmarking.

Early, Postnatal Pulmonary Hypertension Severity Predicts Inpatient Outcomes in Congenital Diaphragmatic Hernia

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Dalya Munves Ferguson ◽  
Vikas S. Gupta ◽  
Pamela A. Lally ◽  
Matias Luco ◽  
KuoJen Tsao ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Systolic Pressure ◽  
Right Ventricular Systolic Pressure ◽  
Ventricular Systolic Pressure ◽  
Inpatient Outcomes ◽  
Increased Risk

<b><i>Introduction:</i></b> Pulmonary hypertension (PH) is the major pathophysiologic consequence of congenital diaphragmatic hernia (CDH). We aimed to evaluate the association between early CDH-associated PH (CDH-PH) and inpatient outcomes. <b><i>Methods:</i></b> The CDH Study Group registry was queried for infants born 2015–2019 with echocardiograms before 48h of life. PH was categorized using echocardiographic findings: none, mild (right ventricular systolic pressure &#x3c;2/3 systemic), moderate (between 2/3 systemic and systemic), or severe (supra-systemic). Univariate and multivariate analyses were performed. Adjusted Poisson regression was used to assess the primary composite outcome of mortality or oxygen support at 30 days. <b><i>Results:</i></b> Of 1,472 patients, 86.5% had CDH-PH: 13.9% mild (<i>n</i> = 193), 44.4% moderate (<i>n</i> = 631), and 33.2% severe (<i>n</i> = 468). On adjusted analysis, the primary outcome of mortality or oxygen support at 30 days occurred more frequently in infants with moderate (incidence rate ratio [IRR] 1.8, 95% confidence interval [CI], 1.2–2.6) and severe CDH-PH (IRR 2.0, 95% CI, 1.3–2.9). Extracorporeal life support (ECLS) utilization was associated only with severe CDH-PH after adjustment (IRR 1.8, 95% CI, 1.0–3.3). <b><i>Discussion/Conclusion:</i></b> Early, postnatal CDH-PH is independently associated with increased risk for mortality or oxygen support at 30 days and utilization of ECLS. Early echocardiogram is a valuable prognostic tool for early, inpatient outcomes in neonates with CDH.

Sign in / Sign up

Export Citation Format

Share Document