Starting and Sustaining an Extracorporeal Membrane Oxygenation Program.

The use of extracorporeal membrane oxygenation (ECMO) is growing rapidly in all patient populations, especially adults for both acute lung or heart failure. ECMO is a complex, high risk, resource-intense, expensive modality that requires appropriate planning, training, and management for successful outcomes. This article provides an optimal approach and the basic framework for initiating a new ECMO program, which can be tailored to meet local needs.

Factors Associated With Survival Following Extracorporeal Cardiopulmonary Resuscitation in Children.

Objectives: We examined a large single-institution experience in extracorporeal cardiopulmonary resuscitation (ECPR) in children having cardiac arrest refractory to conventional resuscitation measures with focus on factors affecting survival.

Methods: Between 2002 and 2017, 184 children underwent ECPR at our institution. We entered demographic, anatomic, clinical, surgical, and ECPR support details into a multivariable logistic regression models to determine factors associated with mortality.

Inotrope Needs in Neonates Requiring Extracorporeal Membrane Oxygenation for Respiratory Failure.

Objective: To evaluate how inotropic requirements in neonates with respiratory failure are affected by extracorporeal membrane oxygenation (ECMO) mode and whether high requirements predict mortality.

Study Design: This retrospective chart review included all neonates undergoing ECMO for primary respiratory failure from 2010 to 2016 at a single institution. The vasoactive inotropy score (VIS) was calculated as described in the literature.

Adult Outcomes After Newborn Respiratory Failure Treated With Extracorporeal Membrane Oxygenation.

Objective: To describe the outcome of young adults treated for hypoxemic respiratory failure with extracorporeal membrane oxygenation as neonates.

Design: The study was designed as a multisite, cross sectional survey.

Setting: The survey was completed electronically or on paper by subjects and stored in a secure data base.

Extracorporeal membrane oxygenator support in infants with systemic-pulmonary shunts.

Background: Management of a patent systemic-pulmonary (SP) shunt and the resulting runoff during extracorporeal membrane oxygenation (ECMO) varies among institutions. We have used a strategy of increased flow without surgical reduction of the shunt diameter, and here report our results with this strategy.

Methods: In this database review of 169 successive veno-arterial ECMO runs performed between 2002 and 2013 in infants and neonates, ECMO flow, time to achieve lactate clearance, normal pH, and negative fluid balance were compared in patients with shunts and those without shunts.

Early renal replacement therapy during pediatric cardiac extracorporeal support increases mortality.

Background: Acute kidney injury is a common comorbidity for children placed on extracorporeal membrane oxygenation (ECMO) because of primary cardiac disease. Continuous venovenous hemofiltration (CVVH) can optimize fluid status and lessen inflammatory response during ECMO. However, published data are derived primarily from children without primary cardiac disease.

Clinical management of the extracorporeal membrane oxygenation circuit.

The clinical management of patients on extracorporeal membrane oxygenation should be standardized and follow clear guidelines or protocols. However, due to the diversity of cannulation strategies and the complex situations that extracorporeal membrane oxygenation is now used in, each extracorporeal membrane oxygenation program has developed its own clinical management strategies. These vary widely across the globe.

Recovery of renal function and survival after continuous renal replacement therapy during extracorporeal membrane oxygenation.

Objective: To assess the outcome of pediatric patients supported by concomitant extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT).

Design, Setting, And Patients: Acute kidney injury is associated with mortality in ECMO patients. CRRT in patients on ECMO provides an efficient and potentially beneficial method of acute kidney injury management.

Experience with use of extracorporeal life support for severe refractory status asthmaticus in children.

Introduction: Severe status asthmaticus (SA) in children may require intubation and mechanical ventilation with a subsequent increased risk of death. In the patient with SA and refractory hypercapnoeic respiratory failure, use of extracorporeal life support (ECLS) has been anecdotally reported for carbon dioxide removal and respiratory support. We aimed to review the experience of a single paediatric centre with the use of ECLS in children with severe refractory SA, and to compare this with international experience from the Extracorporeal Life Support Organization (ELSO) registry.

Validation of the CAS neonatal NIRS system by monitoring vv-ECMO patients: preliminary results.

The CAS neonatal NIRS system determines absolute regional brain tissue oxygen saturation (SnO2) and brain true venous oxygen saturation (SnvO2) non-invasively. Since NIRS-interrogated tissue contains both arterial and venous blood from arterioles, venules, and capillaries, SnO2 is a mixed oxygen saturation parameter, having values between arterial oxygen saturation (SaO2) and cerebral venous oxygen saturation (SvO2). To determine a reference for SnO2, the relative contribution of SvO2 to SaO2 drawn from a brain venous site vs.

Extracorporeal membrane oxygenation for support of children after hematopoietic stem cell transplantation: the Extracorporeal Life Support Organization experience.

Purpose: Extracorporeal membrane oxygenation (ECMO) is a means of respiratory and hemodynamic support for patients failing conventional therapies. Children requiring hematopoietic stem cell transplantation who develop complications during therapy may require ECMO. Such patients pose medical and ethical challenges for clinicians considering initiation of ECMO.

Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis.

Objective: Continuous venovenous hemofiltration (CVVH) is used for renal replacement and fluid management in critically ill children. A previous small study suggested that survival was associated with less percent fluid overload (%FO) in the intensive care unit (ICU) before hemofiltration. We reviewed our experience with a large series of pediatric CVVH patients to evaluate factors associated with outcome.

Hair loss after extracorporeal membrane oxygenation.

Objective: To discuss the factors associated with hair loss reported after the completion of extracorporeal membrane oxygenation.

Design: Prospective survey and retrospective chart review.

Setting: Tertiary care pediatric and adult extracorporeal membrane oxygenation program in a children's hospital.

Primary use of the venovenous approach for extracorporeal membrane oxygenation in pediatric acute respiratory failure.

Objectives: To describe a single center's experience with the primary use of venovenous cannulation for supporting pediatric acute respiratory failure patients with extracorporeal membrane oxygenation (ECMO).

Design: Retrospective chart review of all patients receiving extracorporeal life support at a single institution.

Setting: Pediatric intensive care unit at a tertiary care children's hospital.