The use of therapeutic plasma exchange for pediatric patients supported on extracorporeal membranous oxygenator therapy: A narrative review

Perfusion ◽  
2020 ◽  
pp. 026765912097432
Author(s):  
Reut Kassif Lerner ◽  
Uri Pollak
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Organ Failure ◽  
Plasma Exchange ◽  
English Language ◽  
Pediatric Patients ◽  
Multiple Organ ◽  
Therapeutic Plasma Exchange ◽  
Cochrane Library ◽  
Membrane Oxygenation ◽  
Life Saving

Therapeutic plasma exchange in children is increasingly recognized as a life-saving treatment and is challenged by some technical considerations. As extracorporeal membrane oxygenation has been used for nearly half a century for refractory reversible respiratory and/or cardiac failure in both pediatric and adult populations, it may serve as an extracorporeal platform for therapeutic plasma exchange. It is most commonly described in patients with sepsis with multiple organ failure or thrombocytopenia associated multi organ failure. Additional pathophysiological processes of inflammatory and immunological storms might benefit from the combination of extracorporeal membrane oxygenation and plasma exchange. This is a nonmethodological review of English-language reports of therapeutic plasma exchange performed in patients supported by extracorporeal membrane oxygenation, both pediatric and adult, searching six databases, MEDLINE, Clinical Key, GOOGLE SCHOLAR, CINAHL, Cochrane library, and EMBASE.

scholarly journals Kinetics of Procalcitonin in Pediatric Patients on Extracorporeal Membrane Oxygenation

2018 ◽  
Vol 13 ◽  
pp. 117727191775190 ◽  
Author(s):  
Sara Bobillo ◽  
Javier Rodríguez-Fanjul ◽  
Anna Solé ◽  
Julio Moreno ◽  
Mònica Balaguer ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Prospective Observational Study ◽  
Pediatric Patients ◽  
Clinical Situation ◽  
Multiple Organ ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Membrane Oxygenation ◽  
Neurologic Sequelae ◽  
Kinetics Of

Objectives: To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in pediatric patients who required extracorporeal membrane oxygenation (ECMO) and to analyze its relationship with morbidity and mortality. Patients and methods: Prospective observational study including pediatric patients who required ECMO. Both PCT and CRP were sequentially drawn before ECMO (P0) and until 72 hours after ECMO. Results: A total of 40 patients were recruited. Two cohorts were established based on the value of the P0 PCT (>10 ng/mL). Comparing the kinetics of PCT and CRP in these cohorts, the described curves were the expected for each clinical situation. The cutoff for P0 PCT to predict multiple organ dysfunction syndrome was 2.55 ng/mL (sensibility 83%, specificity 100%). Both PCT and CRP did not predict risk of neurologic sequelae or mortality in any group. Conclusions: Procalcitonin does not seem to be modified by ECMO and could be a good biomarker of evolution.

Therapeutic Plasma Exchange in Children With Thrombocytopenia-Associated Multiple Organ Failure

2019 ◽  
Vol 47 (3) ◽  
pp. e173-e181 ◽  
Author(s):  
James D. Fortenberry ◽  
Trung Nguyen ◽  
Jocelyn R. Grunwell ◽  
Rajesh K. Aneja ◽  
Derek Wheeler ◽  
...  
Keyword(s):  
Multiple Organ Failure ◽  
Organ Failure ◽  
Plasma Exchange ◽  
Multiple Organ ◽  
Therapeutic Plasma Exchange

scholarly journals Use of therapeutic plasma exchange in children with thrombocytopenia-associated multiple organ failure in the Turkish TAMOF network

Critical Care ◽  
2015 ◽  
Vol 19 (Suppl 1) ◽  
pp. P129
Author(s):  
E Sevketoglu ◽  
D Yildizdas ◽  
O Horoz ◽  
H Kihtir ◽  
T Kendirli ◽  
...  
Keyword(s):  
Multiple Organ Failure ◽  
Organ Failure ◽  
Plasma Exchange ◽  
Multiple Organ ◽  
Therapeutic Plasma Exchange

scholarly journals Plasma exchange and early thyroidectomy in thyroid storm requiring extracorporeal membrane oxygenation

2019 ◽  
Vol 2019 ◽  
Author(s):  
Huilin Koh ◽  
Manish Kaushik ◽  
Julian Kenrick Loh ◽  
Chiaw Ling Chng
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Organ Failure ◽  
Plasma Exchange ◽  
Beta Blockers ◽  
Thyroid Storm ◽  
Organ Support ◽  
List Type ◽  
Cardiovascular Collapse ◽  
Membrane Oxygenation ◽  
Multi Organ Failure

Summary Thyroid storm with multi-organ failure limits the use of conventional treatment. A 44-year-old male presented with thyroid storm and experienced cardiovascular collapse after beta-blocker administration, with resultant fulminant multi-organ failure requiring inotropic support, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy. Hepatic and renal failure precluded the use of conventional thyroid storm treatment and early plasma exchange was instituted. The patient underwent emergency thyroidectomy after four effective exchanges, with subsequent rapid reversal of multi-organ failure. The challenges of institution of plasma exchanges with ongoing ECMO support, dialysis and timing of thyroidectomy are discussed. This case highlights the important role of early therapeutic plasma exchange (TPE) as an effective salvage therapy for lowering circulating hormones and stabilization of patients in preparation for emergency thyroidectomy in patients with thyroid storm and fulminant multi-organ failure. Learning points: Administration of beta-blockers in thyroid storm presenting with congestive cardiac failure may precipitate cardiovascular collapse due to inhibition of thyroid-induced hyperadrenergic compensation which maintains cardiac output. TPE can be an effective bridging therapy to emergency total thyroidectomy when conventional thyroid storm treatment is contraindicated. End-organ support using ECMO and CRRT can be combined with TPE effectively in the management of critically ill cases of thyroid storm. The effectiveness of plasma exchange in lowering thyroid hormones appears to wane after 44–48 h of therapy in this case, highlighting the importance early thyroidectomy.

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