Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with improved survival

Abraham, Boban; Gilliam, Erikka; Kim, Dennis W.; Wolf, Michael; Vincent, Robert; Petit, Christopher J.

doi:10.1002/ccd.26526

Cited by 28 publications

(33 citation statements)

References 31 publications

(49 reference statements)

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“…Another retrospective review of 75 catheterizations in pediatric ECLS patients found that the mean ECMO‐to‐catheterization time was shorter in survivors than non‐survivors (1.6 vs. 3.5 days). However, the inclusion of a large number of patients with cardiomyopathy as well as referrals for left atrial decompression may confound these results . Finally, an analysis of 49 catheterizations in pediatric cardiac patients found that those receiving catheterization within 48 hours of ECLS initiation demonstrated less respiratory complications and improved 30‐day survival in comparison to those receiving catheterization beyond 48 hours of ECLS initiation .…”

Section: Discussionmentioning

confidence: 99%

Early Cardiac Catheterization Leads to Shortened Pediatric Extracorporeal Membrane Oxygenation Run Duration

Burke

Chan

Rubio

et al. 2017

J Interven Cardiology

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Section: Discussionmentioning

confidence: 99%

Early Cardiac Catheterization Leads to Shortened Pediatric Extracorporeal Membrane Oxygenation Run Duration

Burke

Chan

Rubio

et al. 2017

J Interven Cardiology

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“…Residual lesions can be identified and, sometimes, addressed via cardiac catheterization. Abraham et al, showed that survival was significantly better with transcatheter interventions compared with no intervention in patients with congenital heart disease . Major catheter complications, requiring surgical intervention, occurred in 7% of catheterizations, no complications occurred during transport, and survival improved if catheterization was done early in the ECMO course (1.6 vs 3.5 days).…”

Section: Discussionmentioning

confidence: 99%

What is new in pediatric ECMO? 2016, a year in review

Roeleveld

2017

European J of Heart Fail

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With the increasing use of extracorporeal membrane oxygenation in children come increasing publications concerning pediatric ECMO. In 2016 important work was done in identifying modifiable risk-factors and possible predictors of mortality in cardiac and respiratory ECMO and risk-estimation scores have been developed for respiratory ECMO patients. Also, increasing important experience is published in the areas of neurodevelopmental follow-up of ECMO survivors. The most relevant publications of 2016 are summarized in this review.

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“…If the patient cannot be weaned off ECLS due to hemodynamic problems, cardiac catheterization should be performed urgently. In a prior study, an 83% survival to discharge rate was reported in pediatric cardiac ECLS patients following catheterization . In this group, 6.7% suffered from major procedural complications.…”

Section: Discussionmentioning

confidence: 82%

“…Postoperative ECLS provides a temporary stabilization of hemodynamics. During this period, clarifying the underlying problem is very important . If the patient cannot be weaned off ECLS due to hemodynamic problems, cardiac catheterization should be performed urgently.…”

Section: Discussionmentioning

confidence: 99%

Initial Clinical Experiences With Novel Diagonal ECLS System in Pediatric Cardiac Patients

et al. 2017

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Extracorporeal life support (ECLS) provides mechanical support following cardiac surgery when respiratory or cardiac failure occurs. The aim of this study was to analyze the safety and feasibility of the Medos Deltastream diagonal pump (DP3) ECLS system in pediatric cardiac patients. We described the technical considerations and risk factors related to the survival outcomes in 102 pediatric cardiac patients who received ECLS support between March 2011 and April 2016. We switched from the DP2 system, which was used for the initial 25 patients, to the DP3 system after November 2012. The DP3 was then used in a consecutive series of 77 patients (4.5% of all pediatric patients who underwent congenital heart surgery during the same time period). The patients' median age was 90 days (range: 2 days-12 years), while their median weight was 4 kg (range: 2.1-40 kg). Fifty four patients (70%) were weaned off ECLS, while 28 patients (36.3%) were successfully discharged from the hospital by means of the DP3 system. The median ECLS duration for survivors was 8.2 days (range: 4-14.5 days). The ECLS indications, durations, and initiation times had no statistical significance in terms of survival. Renal, hemorrhagic, and neurologic complications were all associated with decreased hospital discharge rates (P = 0.003, P = 0.045, and P < 0.001 respectively). Higher lactate levels (P = 0.009) and longer duration for normalization (P < 0.001) were both associated to failure to wean off ECLS support and, hence, to hospital deaths. The weaning rate was 36% prior to November 2012. It increased to 70.3% after that time (P = 0.009). The mechanical complication rate was 9% with the DP3 system and 32% with the DP2, which was statistically significant (P = 0.009). Additionally, the lactate levels were higher and decreased more slowly in the patients supported by the DP2. As a result of the shift to the DP3 system, a revised ECLS protocol, and increased ECLS experience, a significant improvement was observed in our clinical outcomes. The results of this study suggested that the combination of a DP3 pump and a Hilite oxygenator in pediatric ECLS circuits may improve durability and reduce circuit-induced complications.

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Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with improved survival

Cited by 28 publications

References 31 publications

Early Cardiac Catheterization Leads to Shortened Pediatric Extracorporeal Membrane Oxygenation Run Duration

Early Cardiac Catheterization Leads to Shortened Pediatric Extracorporeal Membrane Oxygenation Run Duration

What is new in pediatric ECMO? 2016, a year in review

Initial Clinical Experiences With Novel Diagonal ECLS System in Pediatric Cardiac Patients

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