Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure

Brown, Georgia; Moynihan, Katie; Deatrick, Kristopher B.; Hoskote, Aparna; Sandhu, Hitesh; Aganga, Devon; Deshpande, Shriprasad; Menon, Anuradha; Rozen, Thomas H; Raman, Lakshmi; Alexander, Peta

doi:10.1097/mat.0000000000001431

Cited by 41 publications

(54 citation statements)

References 101 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Historically, EN used to be avoided in patients with shock, as splanchnic circulation can be compromised resulting in mesenteric ischemia, necrotizing enterocolitis, gastrointestinal perforation, or gastrointestinal bleeding ( 23 ); however, most patients on ECMO stabilize within a few hours and inotropes can be withdrawn being considered as stable patients who can be fed ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Pérez

Gonzalez

Zamora

et al. 2021

J. pediatr. gastroenterol. nutr.

View full text Add to dashboard Cite

Objectives: To assess the safety of enteral nutrition (EN) in children on extracorporeal membrane oxygenation (ECMO). To describe nutritional status and the characteristics of the nutritional support in this population. Methods: A retrospective single-center analysis (2006–2016) including children <18 years on ECMO. Demographic data, nutritional status, characteristics of nutritional support, and development of gastrointestinal (GI) complications were recorded. Results: One hundred children, with a median age of 9.7 months (interquartile range [IQR] 3.9–63.1) were enrolled. Undernutrition was prevalent among children on ECMO (33.3%) mainly in patients <2 years ( P = 0.042). Most patients (64%) received EN at some point during ECMO therapy. EN was administered in the first 48 hours after ECMO initiation (48HEN) to 60.3% of the children. Mortality rate in the Pediatric Intensive Care Unit was lower in patients who received EN as the initial artificial nutrition support (ANS) (37.7 vs 51%, P = 0.005) and in children on 48HEN (34% vs 50%, P = 0.04). In the logistic regression analysis, duration of ECMO support and low cardiac output indication were the only factors associated with mortality. Although most patients on ECMO (45%) developed digestive complications, they were mostly mild, being constipation the most prevalent. In the logistic regression analysis, EN was not associated with an increase in GI complications ( P = 0.09). Only three patients developed intestinal ischemia (one without EN and two on EN). Conclusions: Undernutrition is prevalent among children on ECMO, mainly in infants <2 years. EN is not associated with severe gastrointestinal complications or higher mortality in these children.

show abstract

Section: Discussionmentioning

confidence: 99%

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Pérez

Gonzalez

Zamora

et al. 2021

J. pediatr. gastroenterol. nutr.

View full text Add to dashboard Cite

show abstract

“…Within the pediatric congenital heart disease (CHD) population, ECMO is used to support patients with cardiac or cardiorespiratory failure related to pre-operative hemodynamic instability, post-operative low cardiac output syndrome (LCOS), and inability to wean from CPB [1,11]. In recent years, the rapid implementation of venoarterial (VA) ECMO during cardiopulmonary resuscitation [extracorporeal cardiopulmonary resuscitation (ECPR)] has resulted in improved survival, especially in pediatric patients [6].…”

Section: Modern Applicationsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Congenital Heart Disease

et al. 2022

View full text Add to dashboard Cite

Mechanical circulatory support (MCS) is a key therapy in the management of patients with severe cardiac disease or respiratory failure. There are two major forms of MCS commonly employed in the pediatric population—extracorporeal membrane oxygenation (ECMO) and ventricular assist device (VAD). These modalities have overlapping but distinct roles in the management of pediatric patients with severe cardiopulmonary compromise. The use of ECMO to provide circulatory support arose from the development of the first membrane oxygenator by George Clowes in 1957, and subsequent incorporation into pediatric cardiopulmonary bypass (CPB) by Dorson and colleagues. The first successful application of ECMO in children with congenital heart disease undergoing cardiac surgery was reported by Baffes et al. in 1970. For the ensuing nearly two decades, ECMO was performed sparingly and only in specialized centers with varying degrees of success. The formation of the Extracorporeal Life Support Organization (ELSO) in 1989 allowed for the collation of ECMO-related data across multiple centers for the first time. This facilitated development of consensus guidelines for the use of ECMO in various populations. Coupled with improving ECMO technology, these advances resulted in significant improvements in ECMO utilization, morbidity, and mortality. This article will review the use of ECMO in children with congenital heart disease.

show abstract

“…Although the indications and cases of neonatal respiratory ECMO decreased, number of cardiac ECMO cases has progressively increased, even though survival remained low ~40% ( 2 ). The indications for cardiac ECMO include pre-operative hemodynamic stabilization, failure of weaning from cardiopulmonary bypass, low cardiac output syndrome after cardiac surgery, and ECPR ( 32 , 33 ). The incidence of postoperative ECMO currently varies from center to center and ranges from 1.4 to 5% ( 34 ).…”

mentioning

confidence: 99%

Editorial: Neonatal ECMO in 2019: Where Are We Now? Where Next?

et al. 2022

Self Cite

View full text Add to dashboard Cite

Editorial on the Research TopicNeonatal ECMO in 2019: Where Are We Now? Where Next? Despite significant advances in neonatal intensive care, including neonatal ventilation in the current era, extracorporeal membrane oxygenation (ECMO) continues to play a crucial role in selected cases of severe cardio-respiratory failure, potentially reversible, but refractory to conventional ventilatory therapy and maximal pharmacological treatment (1).Our Research Topic attempted to focus on some of continuing challenges in neonatal ECMO. In this issue of Frontiers in Pediatrics, we have collected a wide range of manuscripts related to the use of ECMO in the neonatal period (Broman; Butt and Chiletti; Cashen et al.; Di Nardo et al.; Kersten et al.; Macchini et al.; Perez Ortiz et al.; Rafat and Schaible; Raffaeli et al.; Raffaeli et al.; Roeleveld and Mendonca; Schiller and Tibboel).Since the formation of the Extracorporeal Life Support Organization (ELSO) in 1989, 45,205 newborns have been supported on ECMO in 492 centers (www.elso.org) (2). Respiratory failure was the predominant reason for ECMO utilization in 33,400 newborns, whereas ECMO was used for cardiac failure in 9,561 newborns, and 2,244 were supported for refractory cardiac arrest-extracorporeal cardiopulmonary resuscitation (ECPR). Today, congenital diaphragmatic hernia (CDH) and meconium aspiration syndrome (MAS) are the exclusive neonatal diagnoses that alone represent about 46% of all cases of neonatal respiratory ECMO, reaching 92% of total ECMO if all "others" neonatal ECMO were added (2, 3). The classification of "others" includes all other diagnostic categories such as non-specific respiratory failure, congenital anomaly, pulmonary hypoplasia, hypoxic-ischemic encephalopathy, cardiorespiratory arrest, and inborn errors of metabolism (4). The mortality rate, however, varies significantly depending on the underlying respiratory disease. For instance, neonates with CDH and sepsis have higher mortality rates (47 and 49%, respectively) in contrast to those with MAS (9%) (2). Pulmonary hypertension and lung hypoplasia play a crucial role in determining survival in CDH (5). Neonates with prolonged ECMO run for >21 days have demonstrated higher mortality due to the increased risk of mechanical complications (6).Veno-arterial (V-A) ECMO still represents the support of choice in neonates, with more than 80% receiving V-A support (2). The vessel size is the most critical limiting factor in using the veno-venous (V-V) ECMO in neonates as the smallest double-lumen venous cannula currently commercially available is 13 Fr (3, 7). However, it should be noted that mortality is not significantly different between the two types of support. However, neurological complications are reported to be

show abstract

Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure

Cited by 41 publications

References 101 publications

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Extracorporeal Membrane Oxygenation in Congenital Heart Disease

Editorial: Neonatal ECMO in 2019: Where Are We Now? Where Next?

Contact Info

Product

Resources

About