Extracorporeal Life Support in Pediatric and Neonatal Critical Care: A Review

2004 ◽  
Vol 19 (5) ◽  
pp. 243-258 ◽  
Author(s):  
Laurance Lequier
2021 ◽  
Author(s):  
Jun Ho Lee ◽  
Joo Yeon Kim ◽  
Ilkun Park ◽  
Kiick Sung ◽  
Wook Sung Kim ◽  
...  

Abstract Although a multidisciplinary team (MDT) approach is recommended in advanced heart failure and heart transplantation (HTx), no studies have discussed the impact of the team approach on the clinical outcomes of HTx. In 2014, we established an MDT approach in our HTx program with active involvement of teams for critical care and extracorporeal life support (ECLS) using a real-time online information sharing system. We hypothesized that this MDT approach improved the survival of patients who have undergone HTx. In this study, we enrolled 250 adult patients who underwent HTx between December 2003 and June 2018; they were divided into non-MDT (n = 120; before 2014) and MDT (n = 130; since 2014) groups, with the primary outcome being overall mortality. The mean age of HTx recipients was 51.0 ± 13.7 years, and 77 recipients (30.8%) were female. The MDT group had more high-risk patients in terms of age of donors, diabetes, dialysis, ECLS, and waiting time. Various multivariable analytic methods, including inverse-probability-of-treatment-weighting analysis, revealed that the MDT approach was an independent predictor of overall survival. Therefore, collaboration of an HF team, a critical care team, and an ECLS team may improve survival after HTx.


Pediatric Intensive Care offers providers of critical care to children, from trainees to experienced clinicians, a concise, easy-to-carry resource on pediatric critical care medicine. It is designed for frequent and quick reference at the bedside, providing solutions to questions and situations encountered in practice. The 20 chapters are written by authorities in the field and include citations of some of the most essential references for further reading on each topic. The chapters cover key elements of the practice of pediatric critical care medicine, from cardiopulmonary resuscitation, monitoring, and procedures to extracorporeal life support, sedation and analgesia, and end of life care. Etiology and treatment of all types of organ failure are presented, as are chapters on toxicological emergencies/poisoning, critical care pharmacology, trauma, and burns. The book is sized to fit in a pocket, includes access to electronic, web-based content, and contains focused text, bulleted lists, tables, and figures. The book facilitates the delivery of critical care by residents, fellows, generalists in settings where critical care expertise is not readily available, and practicing intensivists.


2020 ◽  
Vol 99 (10) ◽  

Besides the conventional extracorporeal circulation, commonly used in cardiac surgery, the methods of extracorporeal life support (ECLS) have been applied ever more frequently in thoracic surgery in recent years. The most commonly used modalities of such supports include extracorporeal membrane oxygenation (ECMO) and the Novalung interventional lung assist device (iLA). Successful application of ECLS has led to its more frequent use in general thoracic surgery, especially as a tool to treat hypercapnia and to ensure oxygenation and haemodynamic support. However, these methods are essential in lung transplant programmes; without their help, in most cases, it would not be possible to perform the transplantatioz or prevent the severe complications associated with critical primary graft dysfunction. Additionally, the extracorporeal circulation also facilitates the performing of specific surgical procedures that would not be feasible under standard conditions or would be associated with an inadequate risk. The application of extracorporeal life supports can fundamentally increase the level of resection when treating advanced intrathoracic malignancies that are in close contact with the heart and large vessels or even directly extend into them. Without the possibility of resecting such structures en bloc, together with the tumour, and, thus, achieving an R0 resection, these malignant tumours are often directly contraindicated for surgery or are operated non-radically, i.e. unsuccessfully. Complete tumour resection is the most important prognostic factor in the surgery.


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