Pediatric Extracorporeal Membrane Oxygenation: An Introduction for Emergency Medicine Physicians

Gehrmann, Lynn P.; Hafner, James Lee; Montgomery, Daniel L.; Buckley, Klayton W.; Fortuna, Randall S.

doi:10.1016/j.jemermed.2015.02.010

Cited by 8 publications

(2 citation statements)

References 62 publications

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“…[4,5] ECMO support was considered as an effective therapy when conventional treatments such as medication and ventilation are not efficient in these patients. [6] ECMO is a modified form of cardiopulmonary bypass that can support the heart, circulation, and lungs for days to months. ECMO can be applicated in patients with respiratory failure, sepsis, cardiac arrest, and environmental hypothermia.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of extracorporeal membrane oxygenation in children with refractory cardiopulmonary failure

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Clinical application of extracorporeal membrane oxygenation in children with refractory cardiopulmonary failure

et al. 2016

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“…Extracorporeal membrane oxygenation (ECMO) provides respiratory and circulatory support to critically ill patients. 1,2 Extracorporeal membrane oxygenation support has improved survival in patients requiring significant hemodynamic and respiratory support over the past five decades. 1 It is often used as a bridge to heart and/or lung transplant.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Poor Outcomes in Pediatric Venoarterial Extracorporeal Membrane Oxygenation

Mistry

Trucco

Maul

et al. 2018

World J Pediatr Congenit Heart Surg

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Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides respiratory and hemodynamic support to pediatric patients in severe cardiac failure. We aim to identify risk factors associated with poorer outcomes in this population. Methods: A retrospective chart review was conducted of pediatric patients requiring VA-ECMO support for cardiac indications at our institution from 2004 to 2015. Data were collected on demographics, indication, markers of cardiac output, ventricular assist device (VAD) insertion, heart transplantation, or left atrial (LA) decompression. Univariate Cox proportional hazards models were used to calculate hazard ratios (HRs) for variables associated with the composite primary outcome of transplantfree survival (TFS). Results: Of the 68 reviewed patients, 65% were male, 84% were white, 38% had a prior surgery, 13% had a prior transplant, 10% had a prior ECMO support, and 87.5% required vasoactive support within six hours of cannulation. The ECMO indications included congenital heart disease repaired >30 days prior (12%), cardiomyopathy (41%), posttransplant rejection (7%), and cardiorespiratory failure (40%). The TFS was 54.5% at discharge and 47.7% at one year. Predictors of transplant and/or death include epinephrine use (hazard ratio [HR] ¼ 2.269, P ¼ .041), elevated lactate (HR ¼ 1.081, P ¼ 0005), and elevated creatinine (HR ¼ 1.081, P ¼ .005) within six hours prior to cannulation. Sixteen (23.6%) patients underwent LA decompression. Placement of VAD occurred in 16 (23.5%) patients, for which nonwhite race (HR ¼ 2.94, P ¼ .034) and prior ECMO (HR ¼ 3.42, P ¼ .053) were the only identified risk factors. Conclusions: Need for VA-ECMO for cardiac support carries high inpatient morbidity and mortality. Epinephrine use and elevated lactate and creatinine were associated with especially poor outcomes. Patients who survived to discharge had good short-term follow-up results.

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Blood Lactate as a Reliable Marker for Mortality of Pediatric Refractory Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation

et al. 2019

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Pediatric Extracorporeal Membrane Oxygenation: An Introduction for Emergency Medicine Physicians

Cited by 8 publications

References 62 publications

Clinical application of extracorporeal membrane oxygenation in children with refractory cardiopulmonary failure

Clinical application of extracorporeal membrane oxygenation in children with refractory cardiopulmonary failure

Predictors of Poor Outcomes in Pediatric Venoarterial Extracorporeal Membrane Oxygenation

Blood Lactate as a Reliable Marker for Mortality of Pediatric Refractory Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation

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