Extracorporeal Membrane Oxygenation for Group B Streptococcal Sepsis in Neonates

ECMO and Sepsis

PEDIATRICS ◽

10.1542/peds.90.1.127 ◽

1992 ◽

Vol 90 (1) ◽

pp. 127-127

Author(s):

MICHAEL H. LEBLANC

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Early Onset ◽

Membrane Oxygenation ◽

Streptococcal Sepsis ◽

Group B ◽

Onset Group ◽

Early Onset Group ◽

Ecmo Therapy

To the Editor.— The article by Hocker et al, "Extracorporeal Membrane Oxygenation and Early Onset Group B Streptococcal Sepsis,"1 purports to show that extracorporeal membrane oxygenation (ECMO) is effective in Group B Sepsis. The study begins comparing results prior to ECMO therapy with results after ECMO therapy. The incidence of death from Group B Sepsis went from 3 of 28 or 11% prior to the institution of ECMO to 9 of 53 or 17% after the institution of ECMO.

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Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach?

Perfusion ◽

10.1177/0267659119827231 ◽

2019 ◽

Vol 34 (6) ◽

pp. 453-459 ◽

Cited By ~ 6

Author(s):

Tim Kaufeld ◽

Eric Beckmann ◽

Fabio Ius ◽

Nurbol Koigeldiev ◽

Wiebke Sommer ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Extracorporeal Membrane Oxygenation ◽

Limb Ischemia ◽

Distal Limb ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Limb Perfusion ◽

Group A ◽

Group B

Background: Venoarterial extracorporeal membrane oxygenation support is a well-established tool in the care of severe refractory cardiac and respiratory failure. The application of this support may serve as a bridge to transplant, recovery or to implantation of a ventricular assist device. Venoarterial extracorporeal membrane oxygenation support can be administered through an open surgical access via the common femoral or axillary artery or a percutaneous approach using Seldinger technique. Both techniques may obstruct the blood flow to the lower limb and may cause a significant ischemia with possible limb loss. Malperfusion of the distal limb can be avoided using an ipsilateral distal limb perfusion, which may be established by adding a single-lumen catheter during venoarterial extracorporeal membrane oxygenation treatment to overcome the obstruction. The aim of this study is to distinguish the presence or absence of a distal limb perfusion regarding the incidence of distal limb ischemia. Furthermore, expected risk factors of open and percutaneous femoral venoarterial extracorporeal membrane oxygenation installation were evaluated for the development of distal limb ischemia. Methods: Between January 2012 and September 2015, 489 patients received venoarterial extracorporeal membrane oxygenation support at our institution. In total, 307 patients (204 male, 103 female) with femoral cannulation were included in the analysis. The cohort was distinguished by the presence (group A; n = 237) or absence (group B; n = 70) of a distal limb perfusion during peripheral venoarterial extracorporeal membrane oxygenation treatment. Furthermore, a risk factor analysis for the development of distal limb ischemia was performed. Results: The main indications for venoarterial extracorporeal membrane oxygenation therapy were a low cardiac output syndrome (LCOS) (53%) and failed weaning of extracorporeal circulation (23%). A total of 23 patients (7.49%) under venoarterial extracorporeal membrane oxygenation support developed severe distal limb malperfusion (3.38% in group A vs 21.42% in group B). Preemptive installation of distal limb perfusion extended the intervention-free intervals to 7.8 ± 19.3 days in group A and 6.3 ± 12.5 in group B. A missing distal limb perfusion (p = 0.001) was identified as a main risk factor for critical limb ischemia. Other comorbidities such as arterial occlusion disease (p = 0.738) were not statistically significantly associated. Surgical intervention due to vascular complications after extracorporeal membrane oxygenation explantation was needed in 14 cases (4.22% in group A and 5.71% in group B). Conclusion: We were able to identify the absence of distal limb perfusion as an independent risk factor for the development of critical distal limb ischemia during femoral venoarterial extracorporeal membrane oxygenation treatment. The application of a distal limb perfusion should be considered as a mandatory approach in the context of femoral venoarterial extracorporeal membrane oxygenation treatment regardless of the implantation technique.

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Bronchiolitis Obliterans: A Complication of Group B Streptococcal Disease Treated With Extracorporeal Membrane Oxygenation

PEDIATRICS ◽

10.1542/peds.92.1.157 ◽

1993 ◽

Vol 92 (1) ◽

pp. 157-160

Author(s):

DENNIS E. MAYOCK ◽

P. PEARL O'ROURKE ◽

RAJ P. KAPUR

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Early Onset ◽

Group B Streptococcus ◽

Severe Infection ◽

Minimal Risk ◽

Hearing Disorders ◽

Membrane Oxygenation ◽

Group B Streptococcal Disease ◽

Group B

Group B streptococcus (GBS) is a common cause of severe infection in neonates. In the first days of life, GBS infection presents with sepsis, pneumonia, and cardiovascular collapse. Of those infected, between 25% and 75% will succumb to the disease.1 Nearly half of the children who survive neonatal GBS sepsis suffer significant long-term neurologic morbidity including seizures, mental retardation, hearing disorders, blindness, cerebral palsy, and developmental delays.1,2 The survivors of early-onset GBS pneumonitis appear to have a minimal risk of chronic pulmonary disease, but this has not been studied thoroughly. We describe a neonate with early-onset GBS sepsis and pneumonitis who developed severe respiratory failure requiring extracorporeal membrane oxygenation (ECMO) support.

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Outcomes of out-of-hospital extracorporeal membrane oxygenation transfers: significance of initiation site and personnel

Perfusion ◽

10.1177/0267659119897784 ◽

2020 ◽

Vol 35 (7) ◽

pp. 633-640

Author(s):

Toru Mihama ◽

Spencer Liem ◽

Nicholas Cavarocchi ◽

Hitoshi Hirose

Keyword(s):

Survival Rate ◽

Extracorporeal Membrane Oxygenation ◽

Complication Rate ◽

Survival Rates ◽

University Hospital ◽

Complication Rates ◽

Membrane Oxygenation ◽

Group A ◽

Technical Complication ◽

Group B

Background: Extracorporeal membrane oxygenation is an accepted therapy option for refractory cardiac or respiratory failure. The outcomes of cases initiated at non–extracorporeal membrane oxygenation centers and subsequently transported for management to an extracorporeal membrane oxygenation center require further investigation. Methods: Retrospective institutional review board–approved database research and chart reviews were performed on referrals for extracorporeal membrane oxygenation initially admitted to an outside non–extracorporeal membrane oxygenation center hospital (OSH) then transferred to our extracorporeal membrane oxygenation center (Thomas Jefferson University Hospital (TJUH)). Unstable patients were placed on extracorporeal membrane oxygenation at OSH (Group A) before transport, while others were initiated at our certified extracorporeal membrane oxygenation center (Group B) upon arrival. Group A was further subdivided into patients cannulated by OSH personnel (Group AOSH) or TJUH transport team (Group ATJUH). Outcomes and complications were compared between the different initiation sites and personnel. Results: A total of 108 patients were transferred from August 2010 to June 2018. The technical complication rate for all Group A patients was 33/49 (67%), while that of Group B was 24/59 (41%); p = 0.006. Within Group A, Group AOSH had a greater technical complication rate with 29/33 (88%) than Group ATJUH with 4/16 (25%); p < 0.001. extracorporeal membrane oxygenation survival rate was 34/49 (69%) in Group A and 43/59 (73%) in Group B; p = 0.690. The extracorporeal membrane oxygenation survival rate for Group AOSH and Group ATJUH was 21/33 (64%) and 13/16 (81%), respectively; p = 0.210. Conclusion: Promising extracorporeal membrane oxygenation survival rates were observed in transferred patients. The complication rates related to cannulation technique were significantly higher when patients were initiated at non–extracorporeal membrane oxygenation centers, especially when placed by personnel from non–extracorporeal membrane oxygenation centers.

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