Left Atrial Decompression on Venoarterial Extracorporeal Membrane Oxygenation: Getting to the Heart of the Matter*

Coleman, Ryan; Chartan, Corey; Qureshi, Athar M.; Shekerdemian, Lara

doi:10.1097/pcc.0000000000001956

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Pulmonary hemorrhage is an established complication of left atrial hypertension in cardiogenic shock ( 49 , 50 ). This risk is magnified in the anticoagulated ECMO patient.…”

Section: Resultsmentioning

confidence: 99%

Management of Bleeding and Thrombotic Complications During Pediatric Extracorporeal Membrane Oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference

Rintoul,

McMichael,

Bembea

et al. 2024

Pediatric Critical Care Medicine

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OBJECTIVES: To derive systematic-review informed, modified Delphi consensus regarding the management of bleeding and thrombotic complications during pediatric extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE Consensus Conference. DATA SOURCES: A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021. STUDY SELECTION: The management of bleeding and thrombotic complications of ECMO. DATA EXTRACTION: Two authors reviewed all citations independently, with a third independent reviewer resolving conflicts. Twelve references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form. DATA SYNTHESIS: Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for the management of bleeding and thrombotic complications in pediatric ECMO patients. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was defined as greater than 80% agreement. Two good practice statements, 5 weak recommendations, and 18 consensus statements are presented. CONCLUSIONS: Although bleeding and thrombotic complications during pediatric ECMO remain common, limited definitive data exist to support an evidence-based approach to treating these complications. Research is needed to improve hemostatic management of children supported with ECMO.

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“…Pulmonary hemorrhage is an established complication of left atrial hypertension in cardiogenic shock ( 49 , 50 ). This risk is magnified in the anticoagulated ECMO patient.…”

Section: Resultsmentioning

confidence: 99%

Management of Bleeding and Thrombotic Complications During Pediatric Extracorporeal Membrane Oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference

Rintoul,

McMichael,

Bembea

et al. 2024

Pediatric Critical Care Medicine

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“… 14 LA decompression can quickly reduce LV load, lowering cardiac work and oxygen consumption. 15 Many clinical centers have moved to prophylactic LA decompression because it is hypothesized as the best way to rest the heart. Late LA decompression deployment is likely to lead to worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in children with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation

Sun

Zong

et al. 2022

World Jnl Ped Surgery

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BackgroundPediatric acute fulminant myocarditis (AFM) is a very dangerous disease that may lead to acute heart failure or even sudden death. Previous reports have identified some prognostic factors in adult AFM; however, there is no such research on children with AFM on venoarterial extracorporeal membrane oxygenation (VA-ECMO). This study aimed to find relevant prognostic factors for predicting adverse clinical outcomes.MethodsA retrospective analysis was performed in an affiliated university children’s hospital with consecutive patients receiving VA-ECMO for AFM from July 2010 to November 2020. These children were classified into a survivor group (n=33) and a non-survivor group (n=8). Patient demographics, clinical events, laboratory findings, and electrocardiographic and echocardiographic parameters were analyzed.ResultsPeak serum creatinine (SCr) and peak creatine kinase isoenzyme MB during ECMO had joint predictive value for in-hospital mortality (p=0.011, AUC=0.962). Based on multivariable logistic regression analysis, peak SCr level during ECMO support was an independent predictor of in-hospital mortality (OR=1.035, 95% CI 1.006 to 1.064, p=0.017, AUC=0.936, with optimal cut-off value of 78 μmol/L).ConclusionTissue hypoperfusion and consequent end-organ damage ultimately hampered the outcomes. The need for left atrial decompression indicated a sicker patient on ECMO and introduced additional risk for complications. Earlier and more cautious deployment would likely be associated with decreased risk of complications and mortality.

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“…There is a controversy about the indication, timing, and methodology for left heart decompression (LHD) in patients on venoarterial extracorporeal membrane oxygenation (ECMO) support (1, 2). This is particularly true in the pediatric population because of the scarcity of data and the mixed results reported.…”

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confidence: 99%

Left Heart Decompression on Extracorporeal Membrane Oxygenation Support and Cardiopulmonary Bypass

Puri

Adachi

2021

Pediatric Critical Care Medicine

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Left Atrial Decompression on Venoarterial Extracorporeal Membrane Oxygenation: Getting to the Heart of the Matter*

Cited by 3 publications

References 11 publications

Management of Bleeding and Thrombotic Complications During Pediatric Extracorporeal Membrane Oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference

Management of Bleeding and Thrombotic Complications During Pediatric Extracorporeal Membrane Oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference

Prognostic factors in children with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation

Left Heart Decompression on Extracorporeal Membrane Oxygenation Support and Cardiopulmonary Bypass

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