Abdominal Compartment Syndrome Complicating Paediatric Extracorporeal Life Support: Diagnostic and Therapeutic Challenges

Abstract

We report three paediatric cases, and summarise the reported experience in two others, with cardiorespiratory failure requiring extracorporeal life support for which supportive pump flows could not be maintained due to abdominal compartment syndrome. In two of our patients, the mechanism of abdominal compartment syndrome was massive intra-abdominal fluid extravasation secondary to sepsis, while in the third, the mechanism was post-traumatic intra-abdominal haemorrhage. Although all three children eventually died, decompressive laparotomy and arrest of haemorrhage in the trauma patient restored venous return and enabled technically adequate extracorporeal life support. In two previously reported cases of sepsis with massive fluid resuscitation resulting in abdominal compartment syndrome, one patient died without attempted decompression, while the other patient survived after peritoneal catheter placement restored venous return. Once correctable causes of inadequate venous cannula drainage have been excluded, abdominal compartment syndrome should be considered in any patient on extracorporeal life support with a taut abdomen and reduced venous return. If abdominal compartment syndrome can be proven or is strongly suspected, there may be a role for selective decompressive laparotomy.

The Abdomen in “Thoracoabdominal” Cannot Be Ignored: Abdominal Compartment Syndrome Complicating Extracorporeal Life Support

“…Only one adult case was similar to our report in that the initial insult was caused by a motor vehicle collision. Interestingly, five pediatric cases were reported also involving submersion, respiratory failure requiring ECLS and a decompressive laparotomy for ACS [11, 15]. Similarly to all of the other published case reports where laparotomy was performed (twelve cases), our patient's hemodynamics and biochemical parameters improved initially following decompression [7, 9–11, 15, 16].…”

“…The majority of these, 19 (86%), were identified in the pediatric population [8, 11–15]. Among the case reports involving adults [7, 9, 10, 16], only three (60%) patients underwent a decompressive laparotomy.…”

“…Interestingly, five pediatric cases were reported also involving submersion, respiratory failure requiring ECLS and a decompressive laparotomy for ACS [11, 15]. Similarly to all of the other published case reports where laparotomy was performed (twelve cases), our patient's hemodynamics and biochemical parameters improved initially following decompression [7, 9–11, 15, 16]. This case is unique because of the combination of rare circumstances (adult trauma involving submersion, hypothermia, and ARDS requiring ECLS, followed by ACS requiring laparotomy).…”

“…Unfortunately, our patient died as a result of his anoxic brain injury. Only 5 patients among 22 published cases survived (3 children and 2 young adults) [7–9, 11, 12]. …”

Co-initiation of continuous renal replacement therapy, peritoneal dialysis, and extracorporeal membrane oxygenation in neonatal life-threatening hyaline membrane disease

“…Abdominal distension was increasing markedly, with elevated bladder pressure by a urinary bladder catheter of 23 mmHg, which was noted to have abdominal compartment syndrome according to the criteria of diagnosis. [8,9] In spite of all attempts including nitric oxide inhalation and high-frequency oscillatory ventilation, therapeutic effect was poor.…”