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Extracorporeal membrane oxygenation for refractory septic shock in children: one institution's experience.
Pediatr Crit Care Med. 2007 Sep; 8(5):447-51.PC

Abstract

OBJECTIVE

To report our institutional experience of venoarterial extracorporeal membrane oxygenation (ECMO) in children with septic shock and circulatory collapse.

DESIGN

Retrospective case series.

SETTING

Intensive care unit of a tertiary pediatric referral center.

PATIENTS

Forty-five children with refractory septic shock who received venoarterial ECMO for hemodynamic support.

INTERVENTIONS

Venoarterial ECMO.

MEASUREMENTS AND MAIN RESULTS

We measured mean arterial pressure and inotropes before cannulation, ventilator settings, oxygenation, site and cause of infection, time on ECMO, complications of ECMO relating to the circuit or anticoagulation, survival to hospital discharge, and functional outcome assessment. Between July 1988 and October 2006, 441 children at our institution received extracorporeal life support for a variety of indications. Forty-five (10%) with septic shock received venoarterial ECMO specifically for hemodynamic support. Eighteen (40%) of these had suffered cardiac arrest and were receiving chest compressions immediately before cannulation. The median time spent on ECMO was 84 hrs (range, 32-135). There were mechanical problems with the ECMO circuit requiring intervention in 17 (38%) patients, such as oxygenator or pump head failure, clots in the circuit, or cannulae malposition. This caused no long-term harm in any but one of the patients, who died during a circuit change. Eleven patients (24%) had clinically apparent episodes of bleeding that required surgical intervention or blood transfusion. Twenty-one (47%) patients survived to hospital discharge. Atrioaortic cannulation through a sternotomy incision was associated with an improvement in survival to hospital discharge (73% of those with central cannulation survived vs. 44% without, p = .05). No survivors had severe disability at long-term follow-up.

CONCLUSIONS

Extracorporeal membrane oxygenation can be safely used to resuscitate and support children with sepsis and refractory shock. Sepsis and multiorgan failure should not be considered a contraindication to ECMO. This study adds support to existing guidelines.

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Authors+Show Affiliations

Maclaren G
Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
Butt W
No affiliation info available
Best D
No affiliation info available
Donath S
No affiliation info available
Taylor A
No affiliation info available

MeSH

AdolescentBacterial InfectionsChildChild, PreschoolExtracorporeal Membrane OxygenationFemaleHeart ArrestHumansInfantLength of StayMaleRespiratory InsufficiencyRetrospective StudiesShock, SepticSurvival AnalysisTreatment Outcome

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17693912

Citation

Maclaren, Graeme, et al. "Extracorporeal Membrane Oxygenation for Refractory Septic Shock in Children: One Institution's Experience." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 8, no. 5, 2007, pp. 447-51.
Maclaren G, Butt W, Best D, et al. Extracorporeal membrane oxygenation for refractory septic shock in children: one institution's experience. Pediatr Crit Care Med. 2007;8(5):447-51.
Maclaren, G., Butt, W., Best, D., Donath, S., & Taylor, A. (2007). Extracorporeal membrane oxygenation for refractory septic shock in children: one institution's experience. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 8(5), 447-51.
Maclaren G, et al. Extracorporeal Membrane Oxygenation for Refractory Septic Shock in Children: One Institution's Experience. Pediatr Crit Care Med. 2007;8(5):447-51. PubMed PMID: 17693912.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extracorporeal membrane oxygenation for refractory septic shock in children: one institution's experience. AU - Maclaren,Graeme, AU - Butt,Warwick, AU - Best,Derek, AU - Donath,Susan, AU - Taylor,Anna, PY - 2007/8/19/pubmed PY - 2008/1/4/medline PY - 2007/8/19/entrez SP - 447 EP - 51 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 8 IS - 5 N2 - OBJECTIVE: To report our institutional experience of venoarterial extracorporeal membrane oxygenation (ECMO) in children with septic shock and circulatory collapse. DESIGN: Retrospective case series. SETTING: Intensive care unit of a tertiary pediatric referral center. PATIENTS: Forty-five children with refractory septic shock who received venoarterial ECMO for hemodynamic support. INTERVENTIONS: Venoarterial ECMO. MEASUREMENTS AND MAIN RESULTS: We measured mean arterial pressure and inotropes before cannulation, ventilator settings, oxygenation, site and cause of infection, time on ECMO, complications of ECMO relating to the circuit or anticoagulation, survival to hospital discharge, and functional outcome assessment. Between July 1988 and October 2006, 441 children at our institution received extracorporeal life support for a variety of indications. Forty-five (10%) with septic shock received venoarterial ECMO specifically for hemodynamic support. Eighteen (40%) of these had suffered cardiac arrest and were receiving chest compressions immediately before cannulation. The median time spent on ECMO was 84 hrs (range, 32-135). There were mechanical problems with the ECMO circuit requiring intervention in 17 (38%) patients, such as oxygenator or pump head failure, clots in the circuit, or cannulae malposition. This caused no long-term harm in any but one of the patients, who died during a circuit change. Eleven patients (24%) had clinically apparent episodes of bleeding that required surgical intervention or blood transfusion. Twenty-one (47%) patients survived to hospital discharge. Atrioaortic cannulation through a sternotomy incision was associated with an improvement in survival to hospital discharge (73% of those with central cannulation survived vs. 44% without, p = .05). No survivors had severe disability at long-term follow-up. CONCLUSIONS: Extracorporeal membrane oxygenation can be safely used to resuscitate and support children with sepsis and refractory shock. Sepsis and multiorgan failure should not be considered a contraindication to ECMO. This study adds support to existing guidelines. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/17693912/Extracorporeal_membrane_oxygenation_for_refractory_septic_shock_in_children:_one_institution's_experience_ L2 - https://doi.org/10.1097/01.PCC.0000282155.25974.8F DB - PRIME DP - Unbound Medicine ER -