Joint Statement on Mechanical Circulatory Support in Children

MacLaren, Graeme; Dodge‐Khatami, Ali; Dalton, Heidi J.; Adachi, Iki; Almodovar, Melvin C.; Annich, Gail M.; Bartlett, Robert H.; Bronicki, Ronald A.; Brown, Katherine L.; Butt, Warwick; Cooper, David S.; Demuth, Markus; d’Udekem, Yves; Fraser, Charles D.; Guerguerian, Anne‐Marie; Heard, Micheal; Horton, Steve; Ichord, Rebecca; Jaquiss, Robert D. B.; Laussen, Peter C.; Lequier, Laurance; Lou, Song; Marino, Bradley S.; McMullan, Michael; Ogino, Mark; Peek, Giles; Prêtre, René; Rodefeld, Mark D.; Schmidt, Alicia; Schwartz, Steven S.; Shekerdemian, Lara; Shime, Nobuaki; Sivarajan, Ben; Stiller, Brigitte; Thiagarajan, Ravi R.

doi:10.1097/pcc.0b013e318292dc09

Cited by 18 publications

(4 citation statements)

References 4 publications

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“…After a 24 h fast, general anesthesia was induced by administration of midazolam (0.3 mg/kg intramuscular) and ketamine hydrochloride (15–20 mg/kg intramuscular). Initial propofol and morphine boluses (2 mg/kg intravenous [ 18 ] and 0.1–0.2 mg/kg IV, respectively) were administered, and animals were orotracheally intubated. Continuous IV infusions of propofol (8–10 mg/kg/h) and morphine (0.1–0.2 mg/kg/h) were used to maintain anesthesia.…”

Section: Methodsmentioning

confidence: 99%

Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock

et al. 2015

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BackgroundThe aim of this study was to assess the relationship between extracorporeal blood flow (EBF) and left ventricular (LV) performance during venoarterial extracorporeal membrane oxygenation (VA ECMO) therapy.MethodsFive swine (body weight 45 kg) underwent VA ECMO implantation under general anesthesia and artificial ventilation. Subsequently, acute cardiogenic shock with signs of tissue hypoxia was induced. Hemodynamic and cardiac performance parameters were then measured at different levels of EBF (ranging from 1 to 5 L/min) using arterial and venous catheters, a pulmonary artery catheter and a pressure–volume loop catheter introduced into the left ventricle.ResultsMyocardial hypoxia resulted in a decline in mean (±SEM) cardiac output to 2.8 ± 0.3 L/min and systolic blood pressure (SBP) to 60 ± 7 mmHg. With an increase in EBF from 1 to 5 L/min, SBP increased to 97 ± 8 mmHg (P < 0.001); however, increasing EBF from 1 to 5 L/min significantly negatively influences several cardiac performance parameters: cardiac output decreased form 2.8 ± 0.3 L/min to 1.86 ± 0.53 L/min (P < 0.001), LV end-systolic volume increased from 64 ± 11 mL to 83 ± 14 mL (P < 0.001), LV stroke volume decreased from 48 ± 9 mL to 40 ± 8 mL (P = 0.045), LV ejection fraction decreased from 43 ± 3 % to 32 ± 3 % (P < 0.001) and stroke work increased from 2096 ± 342 mmHg mL to 3031 ± 404 mmHg mL (P < 0.001). LV end-diastolic pressure and volume were not significantly affected.ConclusionsThe results of the present study indicate that higher levels of VA ECMO blood flow in cardiogenic shock may negatively affect LV function. Therefore, it appears that to mitigate negative effects on LV function, optimal VA ECMO blood flow should be set as low as possible to allow adequate tissue perfusion.

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Section: Methodsmentioning

confidence: 99%

Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock

et al. 2015

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“…Sufficient experience with ECMO has accumulated worldwide that it is regarded as a standard of care for cardiogenic shock in both pediatric and adult medicine [ 24 , 25 ]. It is also regarded as a standard of care in refractory neonatal and pediatric respiratory failure [ 6 ].…”

Section: Evidence Of Benefit and Current Role Of Extracorporeal Membrmentioning

confidence: 99%

Extracorporeal membrane oxygenation

Butt¹,

MacLaren²

2013

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Extracorporeal membrane oxygenation (ECMO) is an advanced form of life support technology whereby venous blood is oxygenated outside of the body and returned to the patient. ECMO was initially used as last-resort rescue therapy for patients with severe respiratory failure. Over the last four decades, it has developed into a safe, standard therapy for newborns with progressive cardiorespiratory failure, as a resuscitation therapy after cardiac arrest, and in combination with other treatments such as hypothermia and various blood filtration therapies. ECMO has also become routine for children and adults with all forms of cardiogenic shock and is also routine in early graft failure after transplantation. The one area of ongoing debate is the role of ECMO in adults with hypoxemic respiratory failure. As ECMO equipment becomes safer, earlier use improves patient outcomes. Several modifications of the two basic venovenous and venoarterial ECMO systems are now occurring, as are many minor variations in cannulation strategies and systems of care for patients receiving ECMO. The indications and situations in which ECMO have been tried continue to change, and ECMO for sub-acute and chronic illnesses is now commonplace, as is the use of ECMO in patients with clinical problems previously regarded as contraindications, such as sepsis, malignancy, and immunosuppression.

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“…1 Providing adequate ECMO flow to reverse tissue oxygen debt is imperative in the first few hours of ECMO. Several studies outline the poor outcome which results if lactic acidosis and pH do not improve after institution of ECMO.…”

mentioning

confidence: 99%