Mechanical Circulatory support for Septic Shock in Children and Adults: Different but Similar!

Whilst Extra-Corporeal Membrane Oxygenation (ECMO) for circulatory support in patients with severe septic shock, commenced in newborn infants and children in the late 1980's, ECMO has remained a controversial treatment for adults with refractory septic shock (RSS). This is fundamentally due to differences in the predominant hemodynamic response to sepsis. In newborn infants and very young children ventricular failure called Low Cardiac Output Syndrome (LCOS) is the major hemodynamic response whilst adolescents and adults have mainly vasoplegic shock. ECMO is a very effective treatment for cardiogenic shock even due to sepsis, with a survival that varied from 40-70%; vasoplegic shock however requires vasopressors rather than ECMO and hence survival of these patients with ECMO was poor (<20%). However, since the early 2000's, Sepsis induced Cardiomyopathy (SCM) with ventricular failure (identical to LCOS in children) has been increasingly described in adults and the occurrence of cardiogenic shock due to septic shock is treatable with ECMO. In the last 6 years increasing publications of series of adults with RSS and cardiogenic shock receiving ECMO and ∼70+% surviving has led to increased use of VA ECMO for RSS.