Extracorporeal membrane oxygenation for pediatric respiratory failure: Survival and predictors of mortality*

Zabrocki, Luke; Brogan, Thomas V.; Statler, Kimberly D.; Poss, W. Bradley; Rollins, Michael D.; Bratton, Susan L.

doi:10.1097/ccm.0b013e3181fb7b35

Cited by 234 publications

(219 citation statements)

References 33 publications

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“…Entre un 10 y 30% de los pacientes con HDC presentan a los 10 años de edad episodios de sibilancias y cerca de un 50% tienen hiperinsuflación y episodios de obstrucción de la vía aerea 23 . La sobrevida post ECMO pediátrico es menor comparada con el ECMO neonatal, sin embargo destaca un mejor pronóstico en el grupo con falla respiratoria, especialmente en los pacientes con neumonía aspirativa, neumonía viral y síndrome de distrés respiratorio agudo posoperatorio o traumático 24,25 (figura 6). La neumonía viral es la causa más común de ECMO pediátrico y dentro de sus etiologías la neumonía por virus respiratorio sincicial posee la sobrevida más alta post ECMO con una cifra de un 70% 24 .…”

Section: Pronóstico Y Programas Ecmo En Latinoaméricaunclassified

Oxigenación con membrana extracorpórea neonatal-pediátrica

2013

Rev. chil. pediatr.

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Section: Pronóstico Y Programas Ecmo En Latinoaméricaunclassified

Oxigenación con membrana extracorpórea neonatal-pediátrica

2013

Rev. chil. pediatr.

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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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“…16,17 However, queries of the ELSO registry have shown much higher mortality rates and duration of ECMO for pertussis compared with all respiratory causes. 1 The reason for this disparity is unclear but could be due to the relatively unique combination of respiratory failure and pulmonary hypertension outside of the newborn age group.…”

Section: Discussionmentioning

confidence: 99%

“…We considered placing him on ECMO, which has been used as a rescue strategy for severe neonatal and pediatric respiratory failure. 1,12 Selection criteria for ECMO for pediatric respiratory failure have been proposed, including an FIO 2 .0.6, mean airway pressure .20 cm H 2 O, presence of air leak or barotrauma, a markedly and/or persistently elevated OI, and evidence of reversibility of disease. 13 These criteria were developed on the basis of predictors of mortality of pediatric respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

“…However, the mortality rate for children who required ECMO for pertussis in the ELSO (Extracorporeal Life Support) registry from 1993 to 2007 was 61%, compared with 43% for all causes of respiratory failure. 1 Because of the poor outcome, treatment strategies for severe pertussis other than ECMO should be explored. We report a case of a 2-month-old infant with pertussis, pulmonary hypertension, and severe hypoxemic respiratory failure who satisfied indications for requiring ECMO but was successfully treated with repeated bronchoscopy with suctioning and administration of N-acetylcysteine.…”

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confidence: 99%

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Bronchoscopy With N-Acetylcysteine Lavage in Severe Respiratory Failure From Pertussis Infection

Mata

Sarnaik

2013

Pediatrics

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Pertussis is an illness that causes significant morbidity and mortality, especially in infants younger than 3 months old. In the most severe cases, it can cause pneumonia, respiratory failure, acute respiratory distress syndrome, pulmonary hypertension, and death. There are reports of using rescue extracorporeal membrane oxygenation (ECMO) as a rescue therapy. However, the mortality of ECMO with pertussis is higher than with other causes of pediatric respiratory failure. We report here the case of a 2-month-old boy with severe respiratory failure and pulmonary hypertension who satisfied ECMO criteria but was successfully treated with repeated bronchoscopy with instillation of N-acetylcysteine. Our patient' s respiratory failure was refractory to multiple therapies that have shown benefit in pediatric hypoxemic respiratory failure, including open lung strategies, prone positioning, intratracheal surfactant, and inhaled nitric oxide. Although pulmonary hypertension is a key factor in most cases of fatal pertussis, the adverse effects of hyperinflation and air leaks were more important in this patient' s clinical course. Because bronchiolar obstruction from inflammatory, mucous, and airway epithelial debris can be seen in severe pertussis, a regimen of repeated therapeutic bronchoscopy was initiated, and thick, inspissated secretions were retrieved. The patient' s airway obstruction gradually resolved, and he eventually recovered with minimal sequelae. Pediatrics 2013;132:e1418-e1423

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Extracorporeal membrane oxygenation for pediatric respiratory failure: Survival and predictors of mortality*

Cited by 234 publications

References 33 publications

Oxigenación con membrana extracorpórea neonatal-pediátrica

Oxigenación con membrana extracorpórea neonatal-pediátrica

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

Bronchoscopy With N-Acetylcysteine Lavage in Severe Respiratory Failure From Pertussis Infection

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