The journey of pediatric ECMO

Mehta, Tejas; Sallehuddin, Ahmed; John, Jiju

doi:10.5339/qmj.2017.swacelso.4

Cited by 3 publications

(5 citation statements)

References 26 publications

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“…Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) diagram. PRISMA diagram describes the search methodology and extraction of articles for review (11). ECMO = extracorporeal membrane oxygenation.…”

Section: Methodsmentioning

confidence: 99%

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Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review

Dennis

Jordan

Rice

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES: The number of infants and children requiring extracorporeal membrane oxygenation (ECMO) is rising. While critically ill, providers may believe that enteral nutrition puts the patient at risk for severe complications such as necrotizing enterocolitis. However, enteral nutrition is associated with the potential to improve the gut barrier and reduce the risk of morbidity and mortality. The purpose of this article is to review the existing evidence about providing exclusive enteral and parenteral nutrition and its association with rates of complications and mortality in critically ill neonatal and pediatric populations on ECMO. DATA SOURCES: Literature addressing enteral nutrition while on ECMO for neonatal and pediatric populations was searched using PubMed, CINAHL, and Scopus. STUDY SELECTION: Studies ranged from 1998 to 2022 and were conducted mostly in the PICU and neonatal ICU settings. DATA EXTRACTION: Fourteen articles were reviewed after inclusion and exclusion criteria were applied. DATA SYNTHESIS: Characteristics included an even number of males and females in samples from mostly PICUs. The predominant underlying illnesses were neonatal pulmonary disease and cardiac disease. Upon reviewing the literature, three major themes were revealed: no significant complications with enteral feeding, underutilization of enteral feeding, and reduced mortality with enteral feeding. CONCLUSION: The use of enteral nutrition in the neonatal and pediatric population while on ECMO has the potential to improve survival rates and reduce complications. Further studies are needed to investigate how to optimize this population’s nutrition and develop feeding protocols and pathways.

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Section: Methodsmentioning

confidence: 99%

“…Studies on ECMO in neonates and pediatric patients were not conducted until 1976 and 1996, respectively (11). The earliest studies that identified EN while on ECMO were conducted in 1998 by Piena et al (12) and Pettignano et al (13).…”

Section: Study Selectionmentioning

confidence: 99%

Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review

Dennis

Jordan

Rice

et al. 2023

Pediatric Critical Care Medicine

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“…The cohort in Nagle et al [7], which included patients requiring ECMO for pulmonary and cardiac indication, demonstrated a survival rate to discharge of only 41.7% after 9.4 days of mechanical life support. Current ELSO guidelines estimate survival rates of 50-60% in pediatric cardiac populations, whereas survival rates for ECMO due to pediatric respiratory failure have been described as being as high as 74% [2,21]. Although Nagle et al [7] demonstrated a lower rate of survival, the data provide evidence for efficacy of bivalirudin in short-term ECMO courses and supports the need for further, well-controlled studies.…”

Section: Duration Of Therapymentioning

confidence: 95%

“…In patients with cardiovascular disorders, including congenital heart disease in pediatrics, MCS is often utilized when conventional therapy fails. Extracorporeal membrane oxygenation (ECMO) is useful in patients who require short-term cardiac and/or respiratory support, as it provides complete cardiopulmonary bypass [1,2]. Meanwhile, ventricular assist devices (VADs) have served a variety of uses in patients with heart failure, including long-term use as bridging to transplantation or "destination therapy" in many adults.…”

Section: Introductionmentioning

confidence: 99%

A Review of Bivalirudin for Pediatric and Adult Mechanical Circulatory Support

Taylor

Campbell

Kelly

2020

Am J Cardiovasc Drugs

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“…Reported incidence of abnormal brain imaging in this population is between 28% and 52% (3). The overall survival for neonatal and pediatric patients supported by ECMO is around 60% (4, 5). For patients who develop brain injury, expected survival drops by nearly half (6).…”

mentioning

confidence: 99%

Routine Neuroimaging: Understanding Brain Injury in Pediatric Extracorporeal Membrane Oxygenation*

Farhat¹,

Huet

et al. 2021

Critical Care Medicine

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This project aims to describe brain injuries on routine neuroimaging in a large single-center neonatal and pediatric cohort supported by extracorporeal membrane oxygenation. The study also aims to examine the association of these injuries with neurocognitive outcomes in survivors and identify laboratory findings associated with neurologic injury. DESIGN:Retrospective observational single-center cohort study. SETTING: Tertiary care PICU. PATIENTS: Pediatric patients with noncardiac indications for extracorporeal membrane oxygenation supported by venoarterial or venovenous extracorporeal membrane oxygenation, with on-extracorporeal membrane oxygenation brain CT or postextracorporeal membrane oxygenation brain CT/MRI. INTERVENTIONS: Extracorporeal membrane oxygenation support. MEASUREMENTS AND MAIN RESULTS:Occurrence of brain injury on CT and MRI was reviewed; injuries were scored. Clinical and laboratory results associated with injury were identified. Survivor neurocognitive outcomes were obtained using the Pediatric Overall Performance Category scale and Pediatric Cerebral Performance Category scale. Of 132 imaged patients, 98 (74%) had radiological evidence of brain injury. Mean injury score was 6.5 (± 3.8). Head ultrasounds and clinician suspicion performed poorly in suspecting the presence of injury. Of 104 respondents to neurodevelopmental assessments, 61 (59%) had normal scores; 12.5%, 17%, and 11.5% had mild, moderate, or severe disability. A neuroimaging score greater than 10 was associated with an unfavorable outcome on the Pediatric Cerebral Performance Category (odds ratio, 3.4; p < 0.01) and Pediatric Overall Performance Category (odds ratio, 1.7; p < 0.05). Ischemic injury correlated with worse neurodevelopmental outcome. Preextracorporeal membrane oxygenation lactate, Vasoactive-Inotropic Scores, transaminitis, elevated bilirubin and creatinine levels, and thrombocytopenia were associated with injury occurrence. CONCLUSIONS:Brain injury is frequent in extracorporeal membrane oxygenation patients, although the majority of survivors have favorable neurocognitive outcomes. More research is needed in order to understand the etiology of such injuries. Head ultrasound and clinician suspicion are not sensitive in detecting extracorporeal membrane oxygenation-related brain injuries. Protocolizing postextracorporeal membrane oxygenation imaging with brain MRI allows the identification of injuries and provision of timely neurocognitive intervention.

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The journey of pediatric ECMO

Cited by 3 publications

References 26 publications

Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review

Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review

A Review of Bivalirudin for Pediatric and Adult Mechanical Circulatory Support

Routine Neuroimaging: Understanding Brain Injury in Pediatric Extracorporeal Membrane Oxygenation*

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