The role of extracorporeal membrane oxygenation in pediatric abdominal transplant patients: A qualitative systematic review of literature

Abstract

Background: Advances in ECMO have made it a useful adjunct in critically ill pediatric patients; however, a dearth of evidence exists regarding risks and benefits in pediatric abdominal transplantation. The purpose of this study was to perform a qualitative systematic review of outcomes in pediatric patients undergoing ECMO support preor post-abdominal organ transplantation.Methods: This was a systematic review conducted from Jan 1, 1989, to April 24, 2020, via PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and ClinicalTrials.gov of all pediatric solid abdominal organ transplant recipients (preand post-transplant) and donors who underwent V-A or V-V ECMO cannulation.Death was the primary outcome, with graft function and complications as secondary outcomes.Results: Fourteen articles were identified that fit criteria, with 88% being case reports. Three patients were donors placed on ECMO, with no mortality among the 8 recipients of organs from these donors. Nineteen recipients were placed on ECMO.All were liver transplants. Most patients experienced at least one complication (84%), with bleeding as the most common cause (44%). Mortality was 26%. Causes of death included multiorgan system failure (n = 3), heart failure (n = 1), Systemic inflammatory response syndrome (n = 1), abdominal compartment syndrome (n = 3), bleeding (n = 1), septic shock from aspergillus (n = 1), and hepatic artery thrombosis (n = 2). Conclusions:The data are poor on ECMO usage in pediatric abdominal transplantation. While complications were high, mortality did not appear to be related to ECMO usage and was relatively low given the severity of patient illness.

Rescue venovenous extracorporeal membrane oxygenation for the deterioration of acute respiratory distress syndrome in pediatric liver transplantation

“…Reports on pediatric LT necessitating perioperative management by ECMO are limited. In a recent review article, Reid et al 21 discussed the perioperative indications, complications, and mortality among patients on ECMO in LT. Among 19 cases identified in the literature review (six pre‐LT and 13 post‐LT), the most common indications were HPS and ARDS (26%, respectively), followed by infectious causes (21%), cardiac causes (11%), and pulmonary edema (11%).…”

“…Among 19 cases identified in the literature review (six pre‐LT and 13 post‐LT), the most common indications were HPS and ARDS (26%, respectively), followed by infectious causes (21%), cardiac causes (11%), and pulmonary edema (11%). While complications were high (84%), with bleeding being the most common cause (44%), overall mortality was relatively low (26%), given the severity of patients' illnesses 21 . Although there is a limited report of intraoperative VA‐ECMO in adult, 22 to the best of our knowledge, no reports have been retrieved on pediatric cases rescued intraoperatively by VV‐ECMO during LT.…”

“…While complications were high (84%), with bleeding being the most common cause (44%), overall mortality was relatively low (26%), given the severity of patients' illnesses. 21 Although there is a limited report of intraoperative VA-ECMO in adult, 22 to the best of our knowledge, no reports have been retrieved…”

“…Reports on pediatric LT necessitating perioperative management by ECMO are limited. In a recent review article, Reid et al21 discussed the perioperative indications, complications, and mortality among patients on ECMO in LT.…”

The role of extracorporeal membrane oxygenation in adult liver transplant patients: A qualitative systematic review of literature

“…Regarding the use of ECMO during the post‐operative period in liver recipients, there are only sporadic case reports with minimal comprehensive data, making the transplant community question the overall role for ECMO in this highly regulated field. A recently published qualitative systematic review of literature regarding the role of ECMO in pediatric abdominal transplant patients by our group revealed very limited data and guidelines for the pediatric population 12 . Based on that experience and the unmet need for comprehensive data in the adult population, we performed a qualitative, systematic review regarding outcomes, complications, and mortality for adult patients receiving veno‐venous (VV) or veno‐arterial (VA) ECMO support, either pre– or post–solid organ abdominal transplantation (liver, kidney, pancreas, small bowel, and multi‐visceral transplantation).…”