Refractory pediatric cardiogenic shock: A case for mechanical support

Abstract

Acute left ventricular dysfunction in children justifies aggressive treatment because of the high potential for complete recovery. The options for providing mechanical support to the failing heart in a child include extracorporeal membrane oxygenation, left ventricular assist devices, and the use of the intra-aortic balloon pump (IABP). The IABP is a commonly used method of temporary circulatory support in adults. However, despite the availability of pediatric size balloons, the usage of IABP for temporary circulatory support in children has not been widespread. Current case report, first from India in pediatric age group, aims to aware the pediatric intensivist about the role of IABP in providing temporary mechanical cardiovascular support in managing patients with refractory low cardiac output state.

Oxygen Delivery and Oxygen Consumption in Pediatric Fluid Refractory Septic Shock During the First 42 h of Therapy and Their Relationship to 28-Day Outcome

“…We observed that persistently high gO 2 ER and lack of attainment of critical DO 2 in the initial phases of therapy may identify children in septic shock with chronic tissue oxygen debt progressing to an irreversible shock state and death. This suggests that early options of treatment above the standard is needed in the above sub-set of children, for example, inodilators such as milrinone or levosimendan, or even extracorporeal membrane oxygenation (ECMO) to attain critical DO 2 and save life ( 33 ) ( 34 ). This is because our data suggest that the DO 2 was far short of matching the oxygen need or consumption especially amongst non-survivors.…”