Diverse Morbidity and Mortality Among Infants Treated with Venoarterial Extracorporeal Membrane Oxygenation

Bairdain, Sigrid; Betit, Peter; Craig, Nancy; Rycus, Peter; Wilson, Jay M.; Thiagarajan, Ravi R.

doi:10.7759/cureus.263

Cited by 8 publications

(13 citation statements)

References 44 publications

(36 reference statements)

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“…Although advances in conventional therapies have enabled a decline in the need for ECMO in recent years, respiratory failure remains the most common indication for ECMO among neonates, accounting for approximately 800 ECMO runs per year (5–7). These infants are at high risk of mortality and long-term respiratory and neurologic morbidities, and ongoing research is warranted to optimize pulmonary management and improve outcomes (2, 8–11). …”

Section: Introductionmentioning

confidence: 99%

Lung Rest During Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure—Practice Variations and Outcomes

Alapati¹,

Aghai

Hossain

et al. 2017

Pediatric Critical Care Medicine

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Objective Describe practice variations in ventilator strategies used for lung rest during extracorporeal membrane oxygenation (ECMO) for respiratory failure in neonates, and assess the potential impact of various lung rest strategies on the duration of ECMO and the duration of mechanical ventilation after decannulation. Data Source Retrospective cohort analysis from the extracorporeal life support organization (ELSO) registry database during the years 2008–2013. Study selection All ECMO runs for infants ≤ 30 days of life for pulmonary reasons were included. Data extraction Ventilator type and ventilator settings used for lung rest at 24 hours after ECMO initiation were obtained. Results A total of 3,040 cases met inclusion criteria. Conventional mechanical ventilation (CMV) was used for lung rest in 88% of cases and high frequency ventilation (HFV) was used in 12%. In the CMV group, 32% used positive end expiratory pressure (PEEP) strategy of 4–6 cm H2O (low), 22% used 7–9 cm H2O (mid) and 43% used 10–12 cm H2O (high). HFV was associated with an increased mean (SEM) hours of ECMO [150.2 (0.05) vs. 125 (0.02); p < 0.001] and an increased mean (SEM) hours of mechanical ventilation after decannulation [135 (0.09) vs. 100.2 (0.03); p = 0.002], compared with CMV among survivors. Within the CMV group, use of higher PEEP was associated with a decreased mean (SEM) hours of ECMO [high vs. low: 136 (1.06) vs. 156 (1.06), p = 0.001; mid vs. low: 141 (1.06) vs. 156 (1.06); p = 0.04] but increased duration of mechanical ventilation after decannulation in the high PEEP group compared with low PEEP (p= 0.04) among survivors. Conclusions Wide practice variation exists with regard to ventilator settings used for lung rest during neonatal respiratory ECMO. Use of HFV as compared to CMV and use of low PEEP strategy as compared to mid PEEP and high PEEP strategy is associated with longer duration of ECMO. Further research to provide evidence to drive optimization of pulmonary management during neonatal respiratory ECMO is warranted.

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Section: Introductionmentioning

confidence: 99%

Lung Rest During Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure—Practice Variations and Outcomes

Alapati¹,

Aghai

Hossain

et al. 2017

Pediatric Critical Care Medicine

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“…(1) Although indications have increased exponentially over the years and present promising results, especially as a bridge to heart transplantation, the use of this therapy involves many risks and complications. (2)(3)(4) A 12-year cohort study by the Extracorporeal Life Support Organization (ELSO) (5) which assessed the survival of pediatric patients with an indication for ECMO due heart failure, showed that only 23% survived to hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, low birth weight, incidence of cardiorespiratory arrest, and the need for dialysis were the factors that were independently associated with mortality. (2) Another multicenter study, (6) which evaluated 998 pediatric patients who received ECMO, also due to heart failure, showed that longer use of this therapy was associated with increased mortality, ventilatory weaning time, Intensive Care unit (ICU) length of stay, and hospital costs.…”

Section: Introductionmentioning

confidence: 99%

“…The interest in conducting this study emerged from work as nurses in an ICU of a specialized cardiology center, who routinely attend pediatric patients on ECMO; because of the high complexity of these patients and the care they require; as well as the fact that the studies (2)(3)(4)(5)(6)(7) still demonstrate high mortality rates, unfavorable clinical outcomes and complications related to this therapy, and the observed results with these patients in our service. Thus, our purpose is to identify the factors data related with mortality, and to evaluate the survival of pediatric patients treated with ECMO.…”

Section: Introductionmentioning

confidence: 99%

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Desfechos clínicos de pacientes pediátricos tratados com oxigenação por membrana extracorpórea

et al. 2016

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Objective: To identify factors related to mortality, and evaluate the survival of pediatric patients treated with extracorporeal membrane oxygenation. Methods: A retrospective cohort study that included pediatric patients using the device in the last five years. The groups were divided into those who survived after therapy, and those who did not. Multivariate logistic regression was used for assessing the predictive factors of death, and the Kaplan-Meier and log-rank for assessing survival. Results: Left ventricular ejection fraction was higher in the group of survivors (74% + 14.6% vs 56.2% + 22%, p = 0.038), and the number of patients who required dialysis was higher in the group of non-survivors (52.4% vs. 12.5%, p = 0.039), showing significantly lower survival in this group (log-rank = 0.020). Conclusion: Previous ventricular dysfunction, evidenced by a left ventricular ejection fraction <55%, and requirement of concomitant renal replacement therapy, increased the risk of death. ResumoObjetivo: Identificar os fatores relacionados à mortalidade e avaliar a sobrevida de pacientes pediátricos tratados com oxigenação por membrana extracorpórea. Métodos: Estudo de coorte retrospectivo, que incluiu pacientes pediátricos que utilizaram o dispositivo nos últimos cinco anos. Os grupos foram divididos com base naqueles que sobreviveram ou não após a terapia. Para avaliar os fatores preditivos de morte, foi utilizada análise multivariada com regressão logística e, para a sobrevida, o método de Kaplan-Meier e Log-Rank. Resultados: A fração de ejeção do ventrículo esquerdo era maior no grupo de sobreviventes (74%+14,6% vs 56,2% + 22%, p=0,038) e o número de pacientes que necessitaram de diálise foi maior no grupo de não sobreviventes (52,4% vs. 12,5%, p=0,039), sendo a sobrevida significativamente menor neste grupo (logrank=0,020). Conclusão: Disfunção ventricular prévia, evidenciada pela fração de ejeção do ventrículo esquerdo <55%, e necessidade de terapia de substituição renal concomitante aumentaram o risco de morte.

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“…These include persistent pulmonary hypertension, congenital diaphragmatic hernia, meconium aspiration syndrome, respiratory distress syndrome, pneumonia, severe air-leak syndromes, sepsis and septic shock. (1,2) Even though lifesaving, ECMO introduces a high risk of complications including intravascular haemolysis, bleeding or clot formation, inflammation and sepsis. (3,4) Thrombocytopenia in neonates is a major problem in neonatal intensive care units (NICU), as studies have shown the association of thrombocytopenia with increased mortality, length of hospital stay as well as some major comorbidities such as intraventricular haemorrhage, disseminated intravascular coagulopathy and necrotising enterocolitis.…”

Section: Introductionmentioning

confidence: 99%

Massive RBC fragmentation masks severe thrombocytopenia in both impedance and optical platelet count measurements – a case report of a neonate on ECMO support

2016

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Extracorporeal membranous oxygenation (ECMO) is a life-saving treatment for paediatric patients with cardiac or respiratory failure of diverse aetiology. ECMO support is implemented only when all other available medications and procedures fail to treat the underlying cause of organ failure. The reason for caution is a high risk of complications, including intravascular haemolysis, bleeding or clot formation, inflammation and sepsis. Platelet count is closely monitored in assessment of bleeding risk associated with ECMO support. Platelets are counted as a parameter of the complete blood count and can be measured using impedance or optical technology. We report a case of severe red blood cell (RBC) fragmentation in a neonate on ECMO in whom erroneously normal platelet counts were obtained by all available automated methods for platelet count in an emergency laboratory. Based on those observations we have implemented an additional procedure for recognising interferences of fragmented and microcytic RBCs that cause spuriously normal platelet counts.

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Diverse Morbidity and Mortality Among Infants Treated with Venoarterial Extracorporeal Membrane Oxygenation

Cited by 8 publications

References 44 publications

Lung Rest During Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure—Practice Variations and Outcomes

Lung Rest During Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure—Practice Variations and Outcomes

Desfechos clínicos de pacientes pediátricos tratados com oxigenação por membrana extracorpórea

Massive RBC fragmentation masks severe thrombocytopenia in both impedance and optical platelet count measurements – a case report of a neonate on ECMO support

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