Extracorporeal membrane oxygenation as a bridge to transplant in neonates with fatal pulmonary conditions: A review

Johnson, Brandy L.; Dobkin, Shoshana Leftin; Josephson, Maureen

doi:10.1016/j.prrv.2022.11.001

Cited by 4 publications

(5 citation statements)

References 60 publications

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“…Some centers have used ECMO as a bridge to neonatal lung transplantation in cases of ACD and SFTPB surfactant disorders. [30][31][32] However, not all institutions offer this procedure to newborns and when potentially fatal forms of neonatal lung disease are swiftly identified, multidisciplinary discussions may assess the potential for survival, with or without lung transplantation and determine if futile aggressive lifesustaining treatments should be withdrawn. 8 Altogether, in neonates with critical conditions, both lung biopsy and genetic tests have their intrinsic advantages and limitations.…”

Section: Resultsmentioning

confidence: 99%

“…While some reports have shown prolonged survival in less severe forms of the disease, there are currently no effective treatments for critically severe presentation in newborns. Some centers have used ECMO as a bridge to neonatal lung transplantation in cases of ACD and SFTPB surfactant disorders 30–32 . However, not all institutions offer this procedure to newborns and when potentially fatal forms of neonatal lung disease are swiftly identified, multidisciplinary discussions may assess the potential for survival, with or without lung transplantation and determine if futile aggressive life‐sustaining treatments should be withdrawn 8 .…”

Section: Discussionmentioning

confidence: 99%

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Lung biopsies in infants and children in critical care situation

Levy,

Bitton,

Sileo

et al. 2024

Pediatric Pulmonology

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IntroductionLung biopsy is considered as the last step investigation for diagnosing lung diseases; however, its indication must be carefully balanced with its invasiveness. The present study aims to evaluate the diagnostic yield of lung biopsy in critically ill patients hospitalized in the pediatric intensive care unit (ICU).Material and MethodsChildren who underwent a lung biopsy in the ICU between 1995 and 2022 were included. Biopsies performed in the operating room and post‐mortem biopsies were excluded.ResultsThirty‐one patients were included, with a median age of 18 days (2 days to 10.8 years); 21 (67.7%) were newborns. All patients required invasive mechanical ventilation, 26 (89.7%) had a pulmonary hypertension, and 22 (70.9%) were placed under extracorporeal membrane oxygenation (ECMO). The lung biopsy led to a diagnosis in 81% of the patients. The diagnostic reliability seemed to decrease with age (95% in newborns, 71% in 1 month to 2 years and 0/3 patients aged over 2 years old). Diffuse developmental disorders of the lung accounted for 15 (49%) patients, primarily alveolar capillary dysplasia, followed by surfactant disorders in 5 (16%) patients. Complications occurred in 9/31 (29%) patients including eight under ECMO, with massive hemorrhages in seven cases.Discussion and ConclusionIn critical situations, lung biopsy should be performed. Lung biopsy is a reliable diagnostic procedure for neonates in critical situation when a diffuse developmental disorder of the lung is suspected. The majority of lung biopsy complication was associated with the use of ECMO. The prospective evaluation of the complications of such procedure under ECMO, and particularly over 10 days of ECMO and in children over 2‐year‐old remains to be ascertained.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lung biopsies in infants and children in critical care situation

Levy,

Bitton,

Sileo

et al. 2024

Pediatric Pulmonology

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“…Further ECMO can be complicated by clotting and bleeding in the circuitry as well as by infection. ECMO is also limited to short term use in intensive care settings; there are no current available device options for long term use in ambulatory patients on lung transplant waiting lists or who will not qualify for transplantation ( Johnson et al, 2022 ).…”

Section: Overview Of Lung Regenerative Medicinementioning

confidence: 99%

What is the need and why is it time for innovative models for understanding lung repair and regeneration?

Weiss

2023

Front. Pharmacol.

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Advances in tissue engineering continue at a rapid pace and have provided novel methodologies and insights into normal cell and tissue homeostasis, disease pathogenesis, and new potential therapeutic strategies. The evolution of new techniques has particularly invigorated the field and span a range from novel organ and organoid technologies to increasingly sophisticated imaging modalities. This is particularly relevant for the field of lung biology and diseases as many lung diseases, including chronic obstructive pulmonary disease (COPD) and idiopathic fibrosis (IPF), among others, remain incurable with significant morbidity and mortality. Advances in lung regenerative medicine and engineering also offer new potential avenues for critical illnesses such as the acute respiratory distress syndrome (ARDS) which also continue to have significant morbidity and mortality. In this review, an overview of lung regenerative medicine with focus on current status of both structural and functional repair will be presented. This will serve as a platform for surveying innovative models and techniques for study, highlighting the need and timeliness for these approaches.

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“…[1][2][3] The use of veno-venous (VV) and veno-arterial (VA) ECMO as a bridge to cardiopulmonary recovery or to heart or lung transplantation has dramatically increased in the last decade. 4 In this issue of TRANSFUSION, Bilodeau et al seek to characterize and quantify the various causes of red blood cell (RBC) loss in pediatric patients on ECMO. 5 The authors propose the use of the RBC loss index (RLI), a novel metric based upon changes in hematocrit and the volume of transfused RBCs, calculated as mL of RBCs lost per liter of total (patient + circuit) volume per hour.…”

mentioning

confidence: 99%

“…Extracorporeal membrane oxygenation (ECMO) is a potentially life‐saving intervention for children and adults with severe cardiac or respiratory failure 1–3 . The use of veno‐venous (VV) and veno‐arterial (VA) ECMO as a bridge to cardiopulmonary recovery or to heart or lung transplantation has dramatically increased in the last decade 4 . In this issue of TRANSFUSION , Bilodeau et al seek to characterize and quantify the various causes of red blood cell (RBC) loss in pediatric patients on ECMO 5 .…”

mentioning

confidence: 99%

Disentangling the causes of RBC loss and anemia in ECMO patients: Some questions answered?

2023

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Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving intervention for children and adults with severe cardiac or respiratory failure. [1][2][3] The use of veno-venous (VV) and veno-arterial (VA) ECMO as a bridge to cardiopulmonary recovery or to heart or lung transplantation has dramatically increased in the last decade. 4 In this issue of TRANSFUSION, Bilodeau et al. seek to characterize and quantify the various causes of red blood cell (RBC) loss in pediatric patients on ECMO. 5 The authors propose the use of the RBC loss index (RLI), a novel metric based upon changes in hematocrit and the volume of transfused RBCs, calculated as mL of RBCs lost per liter of total (patient + circuit) volume per hour. They also propose using RBC extracellular vesicle (REV) generation as a marker of sublethal injury to RBCs during ECMO. The investigators suggest that sublethal RBC damage may stimulate extravascular clearance and eventual RBC loss. We applaud the authors on their effort to provide objective metrics for blood loss as well as RBC injury in children on ECMO, and believe that this article should be of great interest to the readers of TRANSFUSION.Transfusion of blood products, such as RBCs, plasma, platelets, and cryoprecipitate, while on ECMO occurs for a variety of reasons. Anemia is common with ECMO and typically attributed to a combination of circuit-related hemolysis, frequent blood sampling for laboratory monitoring, and an increased risk of bleeding given the use of anticoagulants, consumptive coagulopathy, and thrombocytopenia/platelet dysfunction. 6,7 While bleeding remains a principal cause of anemia in patients on ECMO, the authors attempt to quantify the contribution of other etiologies. They note that in the "non-bleeding" ECMO patients, diagnostic phlebotomy accounted for almost a quarter of blood loss, followed by intravascular hemolysis at 16%. This calculation suggested that a majority (up to 60%) of RBC loss in patients without evidence of bleeding was due to other etiologies. Studies have shown that patients supported with ECMO may inadvertently be exposed to RBC transfusion for the treatment of otherwise mild anemia resulting from blood loss, particularly phlebotomy. Frequent phlebotomy and laboratory sampling can contribute to transfusion requirements in more than 50% of patients and have been the sole reason for at least one transfusion in 40% of patients. 7

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Extracorporeal membrane oxygenation as a bridge to transplant in neonates with fatal pulmonary conditions: A review

Cited by 4 publications

References 60 publications

Lung biopsies in infants and children in critical care situation

Lung biopsies in infants and children in critical care situation

What is the need and why is it time for innovative models for understanding lung repair and regeneration?

Disentangling the causes of RBC loss and anemia in ECMO patients: Some questions answered?

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