Pediatric Extracorporeal Life Support Organization Registry International Report 2016

Barbaro, Ryan P.; Paden, Matthew L.; Guner, Yigit S.; Raman, Lakshmi; Ryerson, Lindsay; Alexander, Peta; Nasr, Viviane G.; Bembea, Melania M.; Rycus, Peter; Thiagarajan, Ravi R.

doi:10.1097/mat.0000000000000603

Cited by 406 publications

(421 citation statements)

References 35 publications

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“…The most common bleeding complications during ECMO include intracranial hemorrhage (ICH), surgical site bleeding, and gastrointestinal hemorrhage ( Table 1). Surgical site bleeding is the most frequent complication and occurs in up to 25% of pediatric cardiac and respiratory ECMO patients [1]. Bleeding events are associated with increased mortality [2].…”

Section: Anticoagulation With Unfractionated Heparin In Ecmomentioning

confidence: 99%

“…Anticoagulation during extracorporeal membrane oxygenation (ECMO) is necessary to prevent catastrophic circuit clotting, but it contributes to significant morbidity and mortality. The Extracorporeal Life Support Organization (ELSO) international registry shows a 24% increase in the number of patients placed on ECMO and a 55% growth of centers utilizing ECMO from 2009 to 2015 [1]. Although there has been rapid growth in ECMO around the world, pediatric mortality rates have remained static or even increased depending on the reason for cannulation [1].…”

Section: Introductionmentioning

confidence: 99%

“…The Extracorporeal Life Support Organization (ELSO) international registry shows a 24% increase in the number of patients placed on ECMO and a 55% growth of centers utilizing ECMO from 2009 to 2015 [1]. Although there has been rapid growth in ECMO around the world, pediatric mortality rates have remained static or even increased depending on the reason for cannulation [1]. In a multicenter study, Dalton et al showed that 19-70% of patients had a bleeding event and 12-43% of pediatric patients had a thrombotic event while anticoagulated on ECMO [2].…”

Section: Introductionmentioning

confidence: 99%

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Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation

Weller¹,

Raman²,

Zia³

et al. 2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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Anticoagulation during extracorporeal membrane oxygenation (ECMO) is necessary to prevent catastrophic circuit clotting, but significant morbidity and mortality continue to be attributed to hemorrhagic and thrombotic complications. Due to the inflammatory response from the extracorporeal circuit and developmental hemostasis, anticoagulation can be challenging particularly for pediatric patients. Unfractionated heparin (UFH) is the gold standard anticoagulant used in ECMO, but there is an expanding area of research evaluating other anticoagulants, such as direct thrombin inhibitors. This chapter provides an overview of anticoagulant options for pediatric patients on ECMO as well as describes the various tests used to monitor and titrate anticoagulation.

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Section: Anticoagulation With Unfractionated Heparin In Ecmomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation

Weller¹,

Raman²,

Zia³

et al. 2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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“…ECLS is supportive therapy utilized when traditional therapies have failed, allowing patients time to heal from injury or inflammation, or alternatively providing support until a definitive treatment can be applied. The 2016 Extracorporeal Life Support Organization (ELSO) registry report records that neonates (defined as patients aged 28 days or less at the time of ECLS initiation) comprise the largest group of patients < 18 years of age requiring ECLS . These critically ill neonates have specific nutrition needs and require significant, early, and aggressive nutrition support prescribed by knowledgeable providers.…”

Section: Extracorporeal Life Supportmentioning

confidence: 99%

“…The 2016 Extracorporeal Life Support Organization (ELSO) registry report records that neonates (defined as patients aged 28 days or less at the time of ECLS initiation) comprise the largest group of patients < 18 years of age requiring ECLS. 1 These critically ill neonates have specific nutrition needs and require significant, early, and aggressive nutrition support prescribed by knowledgeable providers. Furthermore, the presence of malnutrition and underweight status is associated with increased mortality in children receiving ECLS.…”

Section: Extracorporeal Life Supportmentioning

confidence: 99%

Neonatal Extracorporeal Life Support: A Review of Nutrition Considerations

2018

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Critically ill neonates who require extracorporeal life support have particular nutrition needs. These infants require prescription of aggressive, early nutrition support by knowledge providers. Understanding the unique metabolic demands and nutrition requirements of these fragile patients is paramount, particularly if additional therapies such as aggressive diuretic regimens or continuous renal replacement therapy are used concurrently. Although the American Society for Parenteral and Enteral Nutrition has published guidelines for this population, a review of each nutrition component is warranted because few studies exist specific to this population. Long-term complications in survivors of neonatal extracorporeal life support, particularly in patients with select diagnoses such as congenital diaphragmatic hernia, can be significant and must be recognized and anticipated. This review focuses on recognizing the nutrition needs of neonatal patients requiring extracorporeal life support, appraising the available data to guide selection of an appropriate mode of nutrition delivery, and describing the anticipated long-term nutrition implications of extracorporeal life support provision during the neonatal period.

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Trends in In-Hospital Cardiac Arrest and Mortality Among Children With Cardiac Disease in the Intensive Care Unit

et al. 2023

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ImportanceData on trends in incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease in the intensive care unit (ICU) are lacking. Additionally, there is limited information on factors associated with IHCA and mortality in this population.ObjectiveTo investigate incidence, trends, and factors associated with IHCA and mortality in children with cardiac disease in the ICU.Data SourcesA systematic review was conducted using PubMed, Web of Science, EMBASE, and CINAHL, from inception to September 2021.Study SelectionObservational studies on IHCA in pediatric ICU patients with cardiac disease were selected (age cutoffs in studies varied from age ≤18 y to age ≤21 y).Data Extraction and SynthesisQuality of studies was assessed using the National Institutes of Health Quality Assessment Tools. Data on incidence, mortality, and factors associated with IHCA or mortality were extracted by 2 independent observers. Random-effects meta-analysis was used to compute pooled proportions and pooled ORs. Metaregression, adjusted for type of study and diagnostic category, was used to evaluate trends in incidence and mortality.Main Outcomes and MeasuresPrimary outcomes were incidence of IHCA and in-hospital mortality. Secondary outcomes were proportions of patients who underwent extracorporeal membrane oxygenation (ECMO) cardiopulmonary resuscitation (ECPR) and those who did not achieve return of spontaneous circulation (ROSC).ResultsOf the 2574 studies identified, 25 were included in the systematic review (131 724 patients) and 18 in the meta-analysis. Five percent (95% CI, 4%-6%) of children with cardiac disease in the ICU experienced IHCA. The pooled in-hospital mortality among children who experienced IHCA was 51% (95% CI, 42%-59%). Thirty-nine percent (95% CI, 29%-51%) did not achieve ROSC; in centers with ECMO, 22% (95% CI, 14%-33%) underwent ECPR, whereas 22% (95% CI, 12%-38%) were unable to be resuscitated. Both incidence of IHCA and associated in-hospital mortality decreased significantly in the last 20 years (both P for trend &lt; .001), whereas the proportion of patients not achieving ROSC did not significantly change (P for trend = .90). Neonatal age, prematurity, comorbidities, univentricular physiology, arrhythmias, prearrest mechanical ventilation or ECMO, and higher surgical complexity were associated with increased incidence of IHCA and mortality odds.Conclusions and RelevanceThis systematic review and meta-analysis found that 5% of children with cardiac disease in the ICU experienced IHCA. Decreasing trends in IHCA incidence and mortality suggest that education on preventive interventions, use of ECMO, and post-arrest care may have been effective; however, there remains a crucial need for developing resuscitation strategies specific to children with cardiac disease.

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Pediatric Extracorporeal Life Support Organization Registry International Report 2016

Cited by 406 publications

References 35 publications

Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation

Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation

Neonatal Extracorporeal Life Support: A Review of Nutrition Considerations

Trends in In-Hospital Cardiac Arrest and Mortality Among Children With Cardiac Disease in the Intensive Care Unit

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