Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases

Objective This study aimed to examine the use of therapeutic plasma exchange (TPE) as adjunctive therapy in neonatal septic shock. Study Design This retrospective cohort study was performed on a convenience sample of neonates in a quaternary children's hospital between January 2018 and February 2019. Results We identified three neonates with septic shock who received TPE. Two neonates had adenovirus sepsis, and one had group B streptococcal sepsis. All neonates were on extracorporeal life support (ECLS) when TPE was started. The median duration of TPE was 6 days (interquartile range [IQR]: 3–15), with a median of four cycles (IQR: 3–5). Lactate levels decreased significantly after TPE (median before TPE: 5.4 mmol/L [IQR: 2.4–6.1] vs. median after TPE: 1.2 mmol/L [IQR: 1.0–5.8]; p < 0.001). Platelet levels did not change (median before TPE: 73,000/mm3 [IQR: 49,000–100,000] vs. median after TPE: 80,000/mm3 (IQR: 62,000–108,000); p = 0.2). Organ failure indices improved after TPE in two of the three neonates. Hypocalcemia was seen in all cases despite prophylactic calcium infusions. One neonate died, and two survived to ICU discharge. Conclusion TPE can be safely performed in neonates with septic shock. TPE may have a role as an adjunctive therapy in neonates with septic shock requiring ECLS.

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Hyperkalemia of the blood-primed ECLS circuit does not result in post-initiation hyperkalemia in infants < 10 kg

Perfusion ◽

10.1191/0267659106pf864oa ◽

2006 ◽

Vol 21 (3) ◽

pp. 173-177 ◽

Cited By ~ 6

Author(s):

Geoffrey M Fleming ◽

Robert T Remenapp ◽

Robert H Bartlett ◽

Gail M Annich

Keyword(s):

Regression Analysis ◽

Cohort Study ◽

Linear Regression ◽

Retrospective Cohort ◽

Potassium Level ◽

Pediatric Patients ◽

Life Support ◽

Extracorporeal Life Support ◽

Linear Regression Analysis ◽

Multivariate Linear Regression Analysis

Objective: To assess the risk of hyperkalemia with blood-primed extracorporeal life support (ECLS) circuits in infants < 10 kg. Design: Retrospective cohort study of all neonatal and pediatric patients <10 kg placed on ECLS from May 1998 to April 2001. Measurements and main results: Data collection including patient weight, patient potassium levels pre- and post-initiation of ECLS, potassium level of the primed ECLS circuit, age of the packed red blood cell (PRBC) unit, type of preservative, and preservative reduction status. Seventy-six circuits were available for the analysis. The age of the PRBC unit and preservative reduction status significantly affected the potassium level of the primed ECLS circuit. Multivariate linear regression analysis showed no significant effect on the post-ECLS initiation patient potassium level with respect to the PRBC age, the preservative reduction status, the patient potassium level prior to ECLS initiation, and the potassium level of the primed ECLS circuit. Conclusions: Initiation of ECLS in infants <10 kg should not be delayed unnecessarily to perform preservative reduction or to utilize PRBC units of a specific age, as hyperkalemia of the primed ECLS circuit is not associated with systemic hyperkalemia in the patient post-initiation of ECLS.

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