Extracorporeal life support for support of children with malignancy and respiratory or cardiac failure: The extracorporeal life support experience*

Abstract

Children with cancer and respiratory failure can be offered ECLS with a reasonable expectation for survival. The opinions of the ELSO center suggest that decisions to offer ECLS to a child with malignancy should be made on a case by case basis, with prognosis of the malignancy being an important factor.

Successful Extracorporeal Membrane Oxygenation for Respiratory Failure in an Infant With DiGeorge Anomaly, Following Thymus Transplantation

“…7 However, another well recognized cause of immunodeficiency is malignancy, and ECMO use is becoming more prevalent in that patient population. Gow et al 8 found, in a series of 86 patients with various malignancies and treated with ECMO, that survival to hospital discharge was better (35%) than in other immunodeficient patients. As part of that investigation, 95% of physicians interviewed indicated that they would consider ECMO in patients with malignancies.…”

“…As part of that investigation, 95% of physicians interviewed indicated that they would consider ECMO in patients with malignancies. 8 Infants with DiGeorge anomaly following thymus transplantation remain substantially immunocompromised for at least 4 -6 months, given the time necessary for immune reconstitution. These infants have a primary T cell immunodeficiency and require ongoing supplementation with intravenous immunoglobulin, especially during periods of critical illness.…”

The evolution of patient selection criteria and indications for extracorporeal life support in pediatric cardiopulmonary failure

“…Eight patients died in hospital after ECLS support for an overall survival to discharge of 35%. 91 Sepsis as an indication has been controversial. Skeptics reasoned that coagulopathy would be difficult to control during ECMO and made the unfounded presumption that the circuit would be colonized by the infecting organism.…”

Extracorporeal Life Support: Moving at the Speed of Light

“…Patients with multiple organ failure from any etiology, septic shock, burns, trauma, airway abnormalities requiring complicated surgical repair, and immunocompromised patients all represent categories of disease that would have precluded ECMO use in the past but have been successfully supported with ECMO in more recent years. [5][6][7][8][9][10][11][12] Neonates While neonates with respiratory failure have formed the largest group of ECLS patients, advancement in prenatal and perinatal care, coupled with therapies and techniques such as inhaled nitric oxide, surfactant replacement, and high-frequency ventilation, have reduced the need for ECLS in many neonates with respiratory failure. 13 Recognition and resolution of persistent pulmonary hypertension of the newborn with some of the therapies mentioned has decreased the need for ECLS in such patients.…”