Extracorporeal membrane oxygenation in children: A brief review

Sakurai, Ken; Singhal, Nitesh

doi:10.1111/jpc.16151

Cited by 13 publications

(11 citation statements)

References 51 publications

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“…Among these, three were excluded based on exclusion criteria (►Fig. 1), specifically that they lacked the pediatric patient-level data elements necessary for our review outcomes or were on an IV DTI at a time other than during ECMO support. The final systematic review was comprised of 28 publications involving 329 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Venovenous (VV) ECMO provides oxygenation and carbon dioxide removal in cases of respiratory failure, whereas venoarterial (VA) ECMO provides cardiac support. 1 Pediatric patients requiring ECMO support vary in size, ranging from neonates around 2 kg up to adult-sized patients. The ECMO cannulas and circuits utilized are tailored to patient size, ranging from tubing that is 1/4” to 3/8” and oxygenators varying from 800 to 7,000 cm 2 , in addition to pump types being centrifugal or roller-pump.…”

Section: Tablementioning

confidence: 99%

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Anticoagulation with Intravenous Direct Thrombin Inhibitors in Pediatric Extracorporeal Membrane Oxygenation: A Systematic Review of the Literature

Kiskaddon,

Do,

Williams

et al. 2023

Semin Thromb Hemost

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Although intravenous (IV) direct thrombin inhibitors (DTI) have gained interest in pediatric extracorporeal membrane oxygenation (ECMO), dosing and safety information is limited. The objective of this systematic review was to characterize DTI types, dosing, monitoring, and outcomes (bleeding and thromboembolic) in pediatric ECMO patients managed with IV DTIs. We conducted searches of MEDLINE (Ovid) and Embase (Elsevier) from inception through December 2022. Case reports, retrospective studies, and prospective studies providing per-patients or summary data for patient(s) <18 years of age receiving IV DTI for ECMO anticoagulation were included. Study selection and data extraction were conducted independently by two reviewers. A total of 28 studies: 14 case reports, 13 retrospective studies, and 1 prospective study were included, totaling 329 patients. Bivalirudin was utilized in 318 (96.7%), argatroban in 9 (2.7%), and lepirudin in 2 (0.6%) patients. Infusion dosing included: bivalirudin 0.14 ± 0.37 mg/kg/h, argatroban 0.69 ± 0.73 µg/kg/min, lepirudin 0.14 ± 0.02 mg/kg/h. Laboratory monitoring tests utilized were the activated clotting time, activated partial thromboplastin time (aPTT), diluted thrombin time, and thromboelastography measures. The aPTT was utilized in most patients (95%). Thromboembolism, bleeding, or death were observed in 17%, 17%, and 23% of bivalirudin, argatroban, and lepirudin patients, respectively. Bivalirudin appears to be the most frequently used DTI in pediatric ECMO. Dosing and laboratory monitoring varied, and bleeding and thromboembolic events were reported in 17% of patients. Prospective studies are warranted to establish dosing, monitoring, safety, and efficacy of bivalirudin and other IV DTI in pediatric ECMO.

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Section: Resultsmentioning

confidence: 99%

Section: Tablementioning

confidence: 99%

Anticoagulation with Intravenous Direct Thrombin Inhibitors in Pediatric Extracorporeal Membrane Oxygenation: A Systematic Review of the Literature

Kiskaddon,

Do,

Williams

et al. 2023

Semin Thromb Hemost

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“…This ambivalence may be particularly acute for parents of infants identified at risk for delay in the perinatal period. Risk may stem from the occurrence of a pre-term, or complicated, birth, as well as from use of life-saving technologies such as ECMO (extra corporeal membrane oxygenation) to address respiratory or cardiac failure in the infant [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Evolution of a System to Monitor Infant Neuromotor Development in the Home: Lessons from COVID-19

et al. 2023

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In the nine months leading up to COVID-19, our biomedical engineering research group was in the very early stages of development and in-home testing of HUGS, the Hand Use and Grasp Sensor (HUGS) system. HUGS was conceived as a tool to allay parents’ anxiety by empowering them to monitor their infants’ neuromotor development at home. System focus was on the evolving patterns of hand grasp and general upper extremity movement, over time, in the naturalistic environment of the home, through analysis of data captured from force-sensor-embedded toys and 3D video as the baby played. By the end of March, 2020, as the COVID-19 pandemic accelerated and global lockdown ensued, home visits were no longer possible and HUGS system testing ground to an abrupt halt. In the spring of 2021, still under lockdown, we were able to resume recruitment and in-home testing with HUGS-2, a system whose key requirement was that it be contactless. Participating families managed the set up and use of HUGS-2, supported by a detailed library of video materials and virtual interaction with the HUGS team for training and troubleshooting over Zoom. Like the positive/negative poles of experience reported by new parents under the isolation mandated to combat the pandemic, HUGS research was both impeded and accelerated by having to rely solely on distance interactions to support parents, troubleshoot equipment, and securely transmit data. The objective of this current report is to chronicle the evolution of HUGS. We describe a system whose design and development straddle the pre- and post-pandemic worlds of family-centered health technology design. We identify and classify the clinical approaches to infant screening that predominated in the pre-COVID-19 milieu and describe how these procedural frameworks relate to the family-centered conceptualization of HUGS. We describe how working exclusively through the proxy of parents revealed the family’s priorities and goals for child interaction and surfaced HUGS design shortcomings that were not evident in researcher-managed, in-home testing prior to the pandemic.

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confidence: 99%

“…Extracorporeal membrane oxygenation (ECMO) is a potentially life‐saving intervention for children and adults with severe cardiac or respiratory failure 1–3 . The use of veno‐venous (VV) and veno‐arterial (VA) ECMO as a bridge to cardiopulmonary recovery or to heart or lung transplantation has dramatically increased in the last decade 4 .…”

mentioning

confidence: 99%

Disentangling the causes of RBC loss and anemia in ECMO patients: Some questions answered?

2023

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Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving intervention for children and adults with severe cardiac or respiratory failure. [1][2][3] The use of veno-venous (VV) and veno-arterial (VA) ECMO as a bridge to cardiopulmonary recovery or to heart or lung transplantation has dramatically increased in the last decade. 4 In this issue of TRANSFUSION, Bilodeau et al. seek to characterize and quantify the various causes of red blood cell (RBC) loss in pediatric patients on ECMO. 5 The authors propose the use of the RBC loss index (RLI), a novel metric based upon changes in hematocrit and the volume of transfused RBCs, calculated as mL of RBCs lost per liter of total (patient + circuit) volume per hour. They also propose using RBC extracellular vesicle (REV) generation as a marker of sublethal injury to RBCs during ECMO. The investigators suggest that sublethal RBC damage may stimulate extravascular clearance and eventual RBC loss. We applaud the authors on their effort to provide objective metrics for blood loss as well as RBC injury in children on ECMO, and believe that this article should be of great interest to the readers of TRANSFUSION.Transfusion of blood products, such as RBCs, plasma, platelets, and cryoprecipitate, while on ECMO occurs for a variety of reasons. Anemia is common with ECMO and typically attributed to a combination of circuit-related hemolysis, frequent blood sampling for laboratory monitoring, and an increased risk of bleeding given the use of anticoagulants, consumptive coagulopathy, and thrombocytopenia/platelet dysfunction. 6,7 While bleeding remains a principal cause of anemia in patients on ECMO, the authors attempt to quantify the contribution of other etiologies. They note that in the "non-bleeding" ECMO patients, diagnostic phlebotomy accounted for almost a quarter of blood loss, followed by intravascular hemolysis at 16%. This calculation suggested that a majority (up to 60%) of RBC loss in patients without evidence of bleeding was due to other etiologies. Studies have shown that patients supported with ECMO may inadvertently be exposed to RBC transfusion for the treatment of otherwise mild anemia resulting from blood loss, particularly phlebotomy. Frequent phlebotomy and laboratory sampling can contribute to transfusion requirements in more than 50% of patients and have been the sole reason for at least one transfusion in 40% of patients. 7

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Extracorporeal membrane oxygenation in children: A brief review

Cited by 13 publications

References 51 publications

Anticoagulation with Intravenous Direct Thrombin Inhibitors in Pediatric Extracorporeal Membrane Oxygenation: A Systematic Review of the Literature

Anticoagulation with Intravenous Direct Thrombin Inhibitors in Pediatric Extracorporeal Membrane Oxygenation: A Systematic Review of the Literature

Evolution of a System to Monitor Infant Neuromotor Development in the Home: Lessons from COVID-19

Disentangling the causes of RBC loss and anemia in ECMO patients: Some questions answered?

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