Extracorporeal Membrane Oxygenation for Neonatal and Pediatric Respiratory Failure

Rehder, Kyle J; Turner, David A.; Cheifetz, Ira M.

doi:10.1097/pcc.0b013e3182a5540d

Cited by 62 publications

(59 citation statements)

References 101 publications

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“…The Pediatric Acute Lung Injury Consensus Conference (PALICC) recently published guidelines outlining research priorities for the field, which include a crucial need for accurate bedside risk-stratification of patients (5–7). Identification of patients at the highest risk of death might enable the targeted application of higher-risk therapies, such as prone positioning, neuromuscular blockade, renal replacement therapy, and extracorporeal life support, and may facilitate stratification for enrollment in clinical trials (8–12). …”

Section: Introductionmentioning

confidence: 99%

A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome*

Spicer

Calfee

Zinter

et al. 2016

Pediatric Critical Care Medicine

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Objective Despite declining mortality, ARDS is still involved in up to one third of pediatric intensive care deaths. The recently convened Pediatric Acute Lung Injury Consensus Conference has outlined research priorities for the field, which include the need for accurate bedside risk-stratification of patients. We aimed to develop a simple yet robust model of mortality risk among pediatric patients with ARDS to facilitate the targeted application of high-risk investigational therapies and stratification for enrollment in clinical trials. Design Prospective, multi-center cohort. Setting Five academic pediatric intensive care units. Patients 308 children ages >1 month and ≤ 18 years, admitted to the intensive care unit, with bilateral infiltrates on chest x-ray and P/F ratio <300 in the clinical absence of left atrial hypertension. Interventions None. Measurements and Main Results Twenty clinical variables were recorded in the following 6 categories: demographics, medical history, oxygenation, ventilation, radiographic imaging, and multi-organ dysfunction. Data were measured 0–24 and 48–72 hours after ARDS onset (Day 1 and Day 3) and examined for associations with hospital mortality. Among 308 enrolled patients, mortality was 17%. Children with a history of cancer and/or hematopoietic stem cell transplant (HSCT) had higher mortality (47% vs. 11%, p<0.001). Oxygenation index (OI), the P/F ratio, extrapulmonary organ dysfunction, PRISM-3, and positive cumulative fluid balance were each associated with mortality. Using two statistical approaches, we found that a parsimonious model of mortality risk using only OI and cancer/HSCT history performed as well as other more complex models that required additional variables. Conclusions In the pediatric intensive care unit, OI and cancer/HSCT history can be used on ARDS Day 1 or Day 3 to predict hospital mortality without the need for more complex models. These findings may simplify risk assessment for clinical trials, counseling families, and high-risk interventions such as extracorporeal life support.

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Section: Introductionmentioning

confidence: 99%

A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome*

Spicer

Calfee

Zinter

et al. 2016

Pediatric Critical Care Medicine

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“…ECMO is an external device that supports the cardiopulmonary system by providing oxygenation and cardiac function for a patient in cardiac and respiratory failure. ECMO has been successfully used in all ages for various medical and surgical conditions leading to cardiovascular collapse, respiratory failure, cardiogenic shock, or refractory hypotension [2][3][4][5][6][7][8][9]. ECMO has also been used in poisoning exposures when cardiac arrest or refractory hypotension develops.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

et al. 2015

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Although there have been many developments related to specific strategies for treating patients after poisoning exposures, the mainstay of therapy remains symptomatic and supportive care. One of the most aggressive supportive modalities is extracorporeal membrane oxygenation (ECMO). Our goal was to describe the use of ECMO for toxicological exposures reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (Tox-IC). We performed a retrospective review of the ACMT ToxIC Registry from January 1, 2010 to December 31, 2013. Inclusion criteria included patients aged 0 to 89 years, evaluated between January 2010 through December 2013, and received ECMO for toxicological exposure. There were 26,271 exposures (60 % female) reported to the ToxIC Registry, 10 (0.0004 %) received ECMO: 4 pediatric (< 12 years), 2 adolescent (12-18 years), and 4 adults (>18 years). Time of initiation of ECMO ranged from 4 h to 4 days, with duration from 15 h to 12 days. Exposures included carbon monoxide/smoke inhalation (2), bitter almonds, methanol, and several medications including antihistamines (2), antipsychotic/ antidepressant (2), cardiovascular drugs (2), analgesics (2), sedative/hypnotics (2), and antidiabetics (2). Four ECMO patients received cardiopulmonary resuscitation (CPR) during their hospital course, and the overall survival rate was 80 %. ECMO was rarely used for poisoning exposures in the ACMT ToxIC Registry. ECMO was utilized for a variety of ages and for pharmaceutical and non-pharmaceutical exposures. In most cases, ECMO was administered prior to cardiovascular failure, and survival rate was high. If available, ECMO may be a valid treatment modality.

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“…Conclusions: Percutaneous cannulation for extracorporeal membrane oxygenation by intensivists can be performed with a high rate of success and a low rate of complications when accompanied by imaging support. (Crit Care Med 2015; 43:1010-1015) Key Words: acute cardiac failure; acute respiratory distress syndrome; extracorporeal life support; extracorporeal membrane oxygenation; intensivist E xtracorporeal life support (ECLS) is a therapeutic option in the management of severe acute respiratory failure when mechanical ventilation and adjunctive measures fail to provide adequate gas exchange or when lung rest cannot be achieved due to high ventilator requirements (1)(2)(3). It is also used for short-term support of acute cardiac failure and for extracorporeal cardiopulmonary resuscitation (ECPR) (4)(5)(6).…”

mentioning

confidence: 99%

Percutaneous Cannulation for Extracorporeal Membrane Oxygenation by Intensivists

Conrad

Grier

Scott

et al. 2015

Critical Care Medicine

101

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Extracorporeal Membrane Oxygenation for Neonatal and Pediatric Respiratory Failure

Cited by 62 publications

References 101 publications

A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome*

A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome*

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

Percutaneous Cannulation for Extracorporeal Membrane Oxygenation by Intensivists

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