Central extracorporeal membrane oxygenation for refractory pediatric septic shock

MacLaren, Graeme; Butt, Warwick; Best, Derek; Donath, Susan

doi:10.1097/pcc.0b013e3181e2a4a1

Cited by 160 publications

(136 citation statements)

References 12 publications

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“…Our institutional approach to VA and VV ECMO has been presented elsewhere [7][8][9]. Our unit has an established system with which to implement ECMO when needed.…”

Section: Methodsmentioning

confidence: 99%

Outcomes in children with refractory pneumonia supported with extracorporeal membrane oxygenation

et al. 2012

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Purpose: To review the use of extracorporeal membrane oxygenation (ECMO) in severe paediatric pneumonia and evaluate factors that may affect efficacy of this treatment. Methods: Retrospective study of the ECMO database of a tertiary paediatric intensive care unit and chart review of all patients who were managed with ECMO during their treatment for severe pneumonia over a 23-year period. The main outcome measures were survival to hospital discharge, and ICU and hospital length of stay. We compared the groups of culture-positive versus culture-negative pneumonia, venoarterial (VA) versus venovenous (VV) ECMO, community-versus hospitalacquired cases, and cases before and after 2005. Results: Fifty patients had 52 cases of pneumonia managed with ECMO. Community-acquired cases were sicker with higher oxygenation index (41.5 ± 20.5 versus 26.8 ± 17.8; p = 0.031) and higher

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“…Our institutional approach to VA and VV ECMO has been presented elsewhere [7][8][9]. Our unit has an established system with which to implement ECMO when needed.…”

Section: Methodsmentioning

confidence: 99%

Outcomes in children with refractory pneumonia supported with extracorporeal membrane oxygenation

et al. 2012

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“…Among those patients, we selected those whose norepinephrine equivalent (the sum of all vasopressors administered, expressed as equivalent doses of norepinephrine) was Ն 1 m g/kg/min for Ն 10 min. We estimated norepinephrine dose equivalences (e-Table 1) based on prior studies, emphasizing studies in septic adults [8][9][10][11][12] rather than children, 13,14 animal models, 15 or healthy adults. 16 Briefl y, we considered 100 m g dopamine equivalent to 1 m g norepinephrine; 1 m g epinephrine equivalent to 1 m g norepinephrine; and 2.2 m g phenylephrine equivalent to 1 m g norepinephrine.…”

Section: Methodsmentioning

confidence: 99%

Survival After Shock Requiring High-Dose Vasopressor Therapy

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Jones

et al. 2013

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Shock is an often lethal syndrome of diminished or insuffi cient perfusion that impairs organ function. Generally associated with decreased arterial blood pressure, shock results most commonly from sepsis, hemorrhage, or primary cardiac failure. 1 Vasopressor medications, largely vasoactive catecholamine hormones, have been used for many decades in the treatment of hypotensive shock. These medications have not been subjected to rigorous, placebo-controlled studies, and consensus from clinical experience suggests that there is not equipoise for such a study in most cases of shock. 2 When vascular tone is profoundly diminished (eg, vasoplegic syndrome or distributive shock), patients may require high-dose vasopressor therapy (HDV).Background: Some patients with hypotensive shock do not respond to usual doses of vasopressor therapy. Very little is known about outcomes after high-dose vasopressor therapy (HDV). We sought to characterize survival among patients with shock requiring HDV. We also evaluated the possible utility of stress-dose corticosteroid therapy in these patients.

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“…RSS is typified by circulatory failure due to septic cardiomyopathy [17–19] with or without vasoplegia [19]. Importantly, effective short-term support of the circulation with newer vasoactive agents or extracorporeal life support (ECLS) [20] means that RSS is potentially reversible [21, 22]. To maximise the impact of these rescue therapies, a robust tool for early identification of RSS is required,…”

Section: Introductionmentioning

confidence: 99%

Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

et al. 2016

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PurposeAlthough overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts’ definition of paediatric RSS.MethodsWe conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality).ResultsFrom the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89–0.94), and 0.956 (95 % CI 0.93–0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality.ConclusionsThis ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-016-4574-2) contains supplementary material, which is available to authorized users.

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Central extracorporeal membrane oxygenation for refractory pediatric septic shock

Abstract: Central ECMO seems to be associated with better survival than conventional ECMO and should be considered by clinicians as a viable strategy in children with refractory septic shock.

Cited by 160 publications

References 12 publications

Outcomes in children with refractory pneumonia supported with extracorporeal membrane oxygenation

Outcomes in children with refractory pneumonia supported with extracorporeal membrane oxygenation

Survival After Shock Requiring High-Dose Vasopressor Therapy

Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

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