Extracorporeal membranous oxygenation (ECMO) in neonates and children – experiences of a multidisciplinary paediatric intensive care unit

Vidmar, Ivan; Primozic, Janez; Kalan, Gorazd; Grosek, Štefan

doi:10.22514/sv31.022008.4

Cited by 6 publications

(4 citation statements)

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“…During the first 24-48 hours of extracorporeal membrane oxygenation support, intravascular volume depletion is common due to capillary leak because of an acute inflammatory like reaction triggered by extracorporeal membrane oxygenation. 22 In our study, we noticed that non-survivors required significantly larger volumes of colloid transfusion (albumin 5%) from 24 to 48 hours of extracorporeal membrane oxygenation initiation and significantly higher extracorporeal membrane oxygenation flow rate at 6, 12, and 24 hours of extracorporeal membrane oxygenation initiation to maintain blood pressure and tissue perfusion comparing with survivors, which could be explained by capillary leak.…”

Section: Discussionmentioning

confidence: 65%

Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery

et al. 2019

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Background:Extracorporeal membrane oxygenation has been widely used after paediatric cardiac surgery due to increasing complex surgical repairs in neonates and infants having complex CHDs.Materials and methods:We reviewed retrospectively the medical records of all patients with CHD requiring corrective or palliative cardiac surgery at King Abdulaziz University Hospital that needed extracorporeal membrane oxygenation support between November 2015 and November 2018.Results:The extracorporeal membrane oxygenation population was 30 patients, which represented 4% of 746 children who had cardiac surgery during this period. The patients’ age range was from 1 day to 20.33 years, with a median age of 6.5 months. Median weight was 5 kg (range from 2 to 53 kg). Twenty patients were successfully decannulated (66.67%), and 12 patients (40%) were survived to hospital discharge. Patients with biventricular repair tended to have better survival rate compared with those with single ventricle palliation (55.55 versus 16.66%, p-value 0.058). During the first 24 hours of extracorporeal membrane oxygenation support, the flow rate was significantly reduced after 4 hours of extracorporeal membrane oxygenation connection in successfully decannulated patients.Conclusion:Survival to hospital discharge in patients requiring extracorporeal membrane oxygenation support after paediatric cardiac surgery was better in those who underwent biventricular repair than in those who had univentricular palliation. Capillary leak on extracorporeal membrane oxygenation could be a risk of mortality in patients after paediatric cardiac surgery.

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Section: Discussionmentioning

confidence: 65%

Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery

et al. 2019

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“…Data from the present study 1) provide a current estimate of CHX contamination in commercially available IV bags and EC circuits and 2) clearly indicate that the effects of 210 g/l IV CHX (a concentration that conservatively approximates clinical exposure for EC patients) mirror the cardiovascular morbidities associated with EC: bradycardia/dysrhythmia (1,4,5,19,33,38), depressed ventricular contractility (1,2,4,5,8,11,18,19,24,33,38,39,41), low cardiac output (7,11,14,28,31), high systemic and pulmonary vascular resistance (7, 13, 18, 29 -31), hypotension/labile blood pressure (2,7,21), pulmonary hypertension (7, 29 -31), impaired neurological (baroreflex) function (3,5,34,38,39), and edema formation (20,32,39).…”

Section: Discussionmentioning

confidence: 64%

Cyclohexanone contamination from extracorporeal circuits impairs cardiovascular function

Thompson-Torgerson¹,

Champion²,

Santhanam³

et al. 2009

American Journal of Physiology-Heart and Circulatory Physiology

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Extracorporeal circulation provides critical life support in the face of cardiopulmonary or renal failure, but it also introduces a host of unique morbidities characterized by edema formation, cardiac insufficiency, autonomic dysfunction, and altered vasomotor function. We tested the hypothesis that cyclohexanone (CHX), a solvent used in production of extracorporeal circuits and intravenous (IV) bags, leaches into the contained fluids and can replicate these clinical morbidities. Crystalloid fluid samples from circuits and IV bags were analyzed by gas chromatography-mass spectrometry to provide a range of clinical CHX exposure levels, revealing CHX contamination of sampled fluids (9.63-3,694 g/l). In vivo rat studies were conducted (n ϭ 49) to investigate the effects of a bolus IV infusion of CHX vs. saline alone on cardiovascular function, baroreflex responsiveness, and edema formation. Cardiovascular function was evaluated by cardiac output, heart rate, stroke volume, vascular resistance, arterial pressure, and ventricular contractility. Baroreflex function was assessed by mean femoral arterial pressure responses to bilateral carotid occlusion. Edema formation was assessed by the ratio of wet to dry organ weights for lungs, liver, kidneys, and skin. CHX infusion led to systemic hypotension; pulmonary hypertension; depressed contractility, heart rate, stroke volume, and cardiac output; and elevated vascular resistance (P Ͻ 0.05). Mean arterial pressure responsiveness to carotid occlusion was dampened after CHX infusion (from ϩ17.25 Ϯ 1.8 to ϩ5.61 Ϯ 3.2 mmHg; P Ͻ 0.05). CHX infusion led to significantly higher wet-to-dry weight ratios vs. saline only (3.8 Ϯ 0.06 vs. 3.5 Ϯ 0.05; P Ͻ 0.05). CHX can reproduce clinical cardiovascular, neurological, and edema morbidities associated with extracorporeal circulatory treatment. ventricular contractility; autonomic nervous system; vasoconstriction; edema EXTRACORPOREAL CIRCULATION [EC; cardiopulmonary bypass, extracorporeal membrane oxygenation (ECMO), hemodialysis, hemofiltration] has become a primary tool in hospitals, providing critical life support in the face of cardiopulmonary or renal failure. However, EC also introduces a host of unique morbidities, including labile blood pressure, depressed cardiac output, ventricular dysfunction, arrhythmias, and major organ edema (1-2, 8, 17-19, 22, 31-33, 40). Although several randomized clinical trials have been conducted to minimize these and other effects of EC treatment (17), EC morbidity rates still remain high and represent a significant barrier to improved patient care, as evidenced by increased time in the intensive care unit (ICU) and on inotropic support.Cyclohexanone [CHX; C 6 H 10 (AO)] is an organic solvent used in the production of polyvinyl chloride (PVC) medical devices, including intravenous (IV) fluid bags and EC circuits. CHX easily migrates from PVC tubing and connections into fluids that come in contact with PVC (10, 12, 35, 37), irrespective of the type of IV fluid. CHX can leach from PVC bags and IV tub...

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“…Rare neuromotor deficits range from mild hypotonia to gross motor delay and spastic quadriparesis. [29][30][31][32][33] Adult patients coming off ECMO after 2 weeks or more often have a picture of severe chronic obstructive poor CO 2 clearance, honeycomb appearance on CXR). This is due to V/Q mismatch which eventually resolves in a few weeks.…”

Section: Predictors Of Mortalitymentioning

confidence: 99%

Extracorporeal membrane oxygenation, an anesthesiologist′s perspective: Physiology and principles. Part 1

Chauhan

Subin

2011

Ann Card Anaesth

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Extracorporeal membrane oxygenation (ECMO) is an adaptation of conventional cardiopulmonary bypass techniques to provide cardiopulmonary support. ECMO provides physiologic cardiopulmonary support to aid reversible aspects of the disease process and to allow recovery. ECMO does not provide treatment of the underlying disease. The indications for ECMO support have expanded from acute respiratory failure to acute cardiac failure refractory to conventional treatments from wide patient subsets involving neonates to adults. Vascular access for ECMO support is either percutaneous through a single-site, dual-lumen bicaval cannula or transthoracic via separate cannulas. The modes of support are either veno-venous or veno-arterial ECMO. In this article, the physiologic aspects of ECMO support are outlined.

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Extracorporeal membranous oxygenation (ECMO) in neonates and children – experiences of a multidisciplinary paediatric intensive care unit

Abstract: ABSTRACT

Cited by 6 publications

References 0 publications

Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery

Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery

Cyclohexanone contamination from extracorporeal circuits impairs cardiovascular function

Extracorporeal membrane oxygenation, an anesthesiologist′s perspective: Physiology and principles. Part 1

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