Extracorporeal and advanced therapies for progressive refractory near‐fatal acute severe asthma in children

Abstract

Asthma is the most common chronic illness and is one of the most common medical emergencies in children. Progressive refractory near‐fatal asthma requiring intubation and mechanical ventilation can lead to death. Extracorporeal membrane oxygenation (ECMO) can provide adequate gas exchange during acute respiratory failure although data on outcomes in children requiring ECMO support for status asthmaticus is sparse with one study reporting survival rates of nearly 85% with asthma being one of the best outcome subsets for patients with refractory respiratory failure requiring ECMO support. We describe the current literature on the use of ECMO and other advanced extracorporeal therapies available for children with acute severe asthma. We also review other advanced invasive and noninvasive therapies in acute severe asthma both before and while on ECMO support.

Volatile anesthetic agents for life‐threatening pediatric asthma: A multicenter retrospective cohort study and narrative review

“…Alternatively, [46][47][48] Yet, the risk of acute and chronic complications (eg, hemorrhage, cerebral infarction, end-organ failure, and mortality) may deter providers from applying early extracorporeal life support prior to application of other rescue therapies. 49 Additional considerations include expected and unexpected anesthesia-related adverse effects, the most common being hypotension. 22,26,28 This well-described complication is due to a combination of myocardial depression and systemic vasodilation that can be mitigated with simple volume resuscitation or vasoactive administration to prevent perfusion deficits leading to end-organ dysfunction.…”