Extracorporeal membrane oxygenation (ECMO) is currently used to support patients of all ages with acute severe respiratory failure non-responsive to conventional treatments, and although initial use was almost exclusively in neonates, use for this age group is decreasing while use in older children remains stable (300-500 cases annually) and support for adults is increasing. Recent advances in technology include: refinement of double lumen veno-venous (VV) cannulas to support a large range of patient size, pumps with lower prime volumes, more efficient oxygenators, changes in circuit configuration to decrease turbulent flow and hemolysis. Veno-arterial (VA) mode of support remains the predominant type used; however, VV support has lower risk of central nervous injury and mortality. Key to successful survival is implementation of ECMO before irreversible organ injury develops, unless support with ECMO is used as a bridge to transplant. Among pediatric patients treated with ECMO mortality varies by pulmonary diagnosis, underlying condition, other non-pulmonary organ dysfunction as well as patient age, but has remained relatively unchanged overall (43%) over the past several decades. Additional risk factors associated with death include prolonged use of mechanical ventilation (> 2 wk) prior to ECMO, use of VA ECMO, older patient age, prolonged ECMO support as well as complications during ECMO. Medical evidence regarding daily patient management specifically related to ECMO is scant, it usually mirrors care recommended for similar patients treated without ECMO. Linkage of the Extracorporeal Life Support Organization dataset with other databases and collaborative research networks will be required to address this knowledge deficit as most centers treat only a few pediatric respiratory failure patients each year.

These data suggest limited efficacy for rFVIIa use for refractory hemorrhage in pediatric patients on ECMO support. There were two non-catastrophic complications temporally associated with its administration.

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Pediatric adrenal insufficiency is often thought to mainly affect patient with congenital adrenal hyperplasia (CAH) in the newborn period. However, many cases occur outside of infancy and are not related to CAH. They often presents in an insidious nature with symptoms attributed to more common and often benign etiologies. Unfortunately, if not diagnosed early, adrenal insufficiency can lead to acute adrenal crisis with hemodynamic collapse. We present the case of a 15-year-old young man with a history of hypothyroidism who presented to an ED and developed hypotension and wide complex tachycardia due to hyperkalemia. After initial fluid resuscitation and treatment for his arrhythmia, he was then emergently transported to our hospital for further work up and care. Laboratory studies ultimately diagnosed him with Autoimmune Polyendocrinopathy Syndrome Type II leading to adrenal crisis.