Inotrope Needs in Neonates Requiring Extracorporeal Membrane Oxygenation for Respiratory Failure

Sewell, Elizabeth; Piazza, Anthony J.; Davis, James B.; Heard, Micheal; Figueroa, Janet; Keene, Sarah

doi:10.1016/j.jpeds.2019.07.029

Cited by 6 publications

(2 citation statements)

References 22 publications

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“…Surprisingly, pre-ECLS degree of cardiorespiratory failure did not affect in-hospital mortality, whereas the persistent need of inotropic support and lactatemia at 24 hours post-ECLS initiation were predictive of in-hospital mortality. Sewell et al 12 described a similar finding in their neonatal experience, ascribing this to unsuitable selection of initial VV-support rather than VA or poor response to ECLS treatment itself. All our immunocompromised patients with malignancy did not survive, reinforcing the reported dismal outcomes in these population.…”

Section: Discussionmentioning

confidence: 68%

Venoarterial to venovenous extracorporeal life support conversion in pediatric acute respiratory distress syndrome

et al. 2021

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In patients with pediatric acute respiratory distress syndrome (PARDS) and hemodynamic compromise who need venoarterial (VA) extracorporeal life support (ECLS), we have adopted a strategy to promote early VA-to-venovenous (VV) conversion since 2018. A single-center retrospective review was performed of all 22 patients who underwent ECLS for PARDS from 2008 to 2019. Variables were analyzed to determine factors affecting initial cannulation mode and in-hospital mortality. Outcomes were compared between before and after 2018. Of the 22 patients, 9 patients underwent initial VA-support. Small patient size and severe cardiopulmonary compromise prior to ECLS favored initial VA- over VV-support. Lactate level and vasoactive inotrope score at 24 hours post-ECLS initiation predicted in-hospital mortality. After 2018, all five patients with initial VA-support were converted to VV-support at 4.4 ± 1.3 days post-ECLS initiation without complications. In-hospital mortality decreased after 2018 (3/9) compared with before (10/13) (p = 0.041) despite longer ECLS run time (723.4 ± 384.2 vs 286.5 ± 235.1 hours, p = 0.003). The number of ECLS-related complications per ECLS 1000 run hours decreased after 2018 (7.2 ± 4.2 vs 46.9 ± 66.5, p = 0.063). Our strategy to promote early VA-to-VV conversion may be worth further evaluation in larger cohort studies.

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Section: Discussionmentioning

confidence: 68%

Venoarterial to venovenous extracorporeal life support conversion in pediatric acute respiratory distress syndrome

et al. 2021

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“…Adequate ECMO flows (median 126 mL/kg/min) and patient saturations were achieved in a heterogeneous population of nonambulatory children of whom seven had comorbidities including chronic lung disease, pulmonary hypertension, and immunodeficiency. Seven patients had a significant inotrope requirement (VIS ≥ 30) with none requiring conversion to V-A ECMO; they received higher levels of support than most patients in case series reporting the use of ECMO in inotropedependent neonatal and pediatric respiratory patients (16,17). This cannulation method achieved flows that were stable, with minimal recirculation on ECMO runs extending to 28 days and included some patients being positioned prone.…”

Section: Discussionmentioning

confidence: 99%

Multisite Veno-Venous Cannulation for Neonates and Nonambulatory Children*

Lillie

Pienaar

Budd

et al. 2021

Pediatric Critical Care Medicine

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OBJECTIVES:Neonates with respiratory failure are ideally supported with veno-venous rather than veno-arterial extracorporeal membrane oxygenation due to the reduced rate of neurologic complications. However, the proportion of neonates supported with veno-venous extracorporeal membrane oxygenation is declining. We report multisite veno-venous extracorporeal membrane oxygenation, accessing the neck, returning to the inferior vena cava via the common femoral vein in neonates and children less than 10 kg. DESIGN:Retrospective case series with 1 year minimum follow-up.PATIENTS: Patients less than 10 kg supported with veno-venous extracorporeal membrane oxygenation accessing the jugular and returning to the femoral vein SETTING: A 30-bed pediatric intensive care delivering extracorporeal membrane oxygenation to approximately 20 children annually. INTERVENTIONS:Veno-venous extracorporeal membrane oxygenation accessing the jugular and returning to the femoral vein was delivered using two single lumen cannulae. MEASUREMENTS AND MAIN RESULTS:January 2015 to August 2019, 11 patients underwent veno-venous extracorporeal membrane oxygenation accessing the jugular and returning to the femoral vein with median weight of 3.6 kg (interquartile range 2.8-6.1 kg), and median corrected gestational age of 13 days (interquartile range, 2-175 d). The smallest patient weighed 2.1 kg. Seven patients had comorbidities. Extracorporeal membrane oxygenation was technically successful in all patients with median flows of 126 mL/kg/min (interquartile range, 120-138 mL/kg/min) and median arterial oxygenation saturation of 94% (interquartile range, 91-98%) at 24 hours. Nine survived to home discharge, and two were palliated. Common femoral vein occlusion was observed in all patients on ultrasound post decannulation. There was no clinical or functional deficit in the cannulated limb at follow-up, a minimum of 1 year post extracorporeal membrane oxygenation. CONCLUSIONS:Veno-venous extracorporeal membrane oxygenation accessing the jugular and returning to the femoral vein was performed safely in patients under 10 kg with the smallest patient weighing 2.1 kg. Although occlusion of the common femoral vein was observed in patients post decannulation, subsequent follow-up demonstrated no clinical implications. We challenge current practice that veno-venous extracorporeal membrane oxygenation accessing the jugular and returning to the femoral vein cannot be performed in nonambulatory patients and suggest that this strategy is preferred over veno-arterial extracorporeal membrane oxygenation in infants requiring extracorporeal membrane oxygenation for respiratory failure.

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Fetal MRI mediastinal shift angle and respiratory and cardiovascular pharmacological support in newborns with congenital diaphragmatic hernia

et al. 2021

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Introduction. In newborns with congenital diaphragmatic hernia (CDH), the mediastinal shift caused by the herniated organs negatively affects lung development. Assessment of the fetal magnetic resonance imaging (MRI) mediastinal shift angle (MSA) was shown to have an inverse correlation with the total fetal lung volume (TFLV), being associated with neonatal survival. However, a possible association with postnatal morbidity has never been investigated.We hypothesize that the degree of the mediastinal shift could be associated with higher respiratory and cardiocirculatory impairment, requiring intensive treatments and extended hospitalization in survivors.Method. We retrospectively consider a cohort of isolated, left-sided CDH, for whom we calculated the MSA and the observed/expected (O/E) TFLV at fetal MRI. We performed a data collection regarding inotropic or vasoactive support, treatment with pulmonary vasodilators, mechanical ventilation, and length of stay. General linear models were performed.Results. The MSA and O/E TFLV were inversely correlated (Pearson's coe cient -0.65, p < 0.001) and deceased patients showed higher MSA values then survivors (p = 0.011

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Inotrope Needs in Neonates Requiring Extracorporeal Membrane Oxygenation for Respiratory Failure

Cited by 6 publications

References 22 publications

Venoarterial to venovenous extracorporeal life support conversion in pediatric acute respiratory distress syndrome

Venoarterial to venovenous extracorporeal life support conversion in pediatric acute respiratory distress syndrome

Multisite Veno-Venous Cannulation for Neonates and Nonambulatory Children*

Fetal MRI mediastinal shift angle and respiratory and cardiovascular pharmacological support in newborns with congenital diaphragmatic hernia

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