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O'Neil ER, Guner Y, Anders MM, Priest J, Friedman ML, Raman L, Di Nardo M, Alexander P, Tonna JE, Rycus P, Thiagarajan RR, Barbaro R, Sandhu HS. Pediatric Highlights From the Extracorporeal Life Support Organization Registry: 2017-2022. ASAIO J 2024; 70:8-13. [PMID: 37949062 DOI: 10.1097/mat.0000000000002078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
The Extracorporeal Life Support Organization (ELSO) registry which collects data from hundreds of participating centers supports research in ECMO to help improve patient outcomes. The ELSO Scientific Oversight Committee, an international and diverse group of ECMOlogists ( https://www.elso.org/registry/socmembers.aspx ), selected the most impactful and innovative research articles on pediatric ECMO emerging from ELSO data. Here they present brief highlights of these publications.
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Affiliation(s)
- Erika R O'Neil
- From the Department of Pediatrics, United States Air Force, Brooke Army Medical Center, San Antonio, Texas
| | - Yigit Guner
- University of California Irvine Department of Surgery, Children's Hospital of Orange County, California
| | - Marc M Anders
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - John Priest
- Department of Respiratory Care/ECMO Program, Boston Children's Hospital, Boston, Massachusetts
| | - Matthew L Friedman
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Lakshmi Raman
- University of Texas Southwestern, UT Southwestern Medical Center, Dallas, Texas
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery and Department of Emergency Medicine, University of Utah Health, Salt Lake City, Utah
| | - Peter Rycus
- Extracorporeal Life Support Organization, Ann Arbor, Michigan
| | - Ravi R Thiagarajan
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ryan Barbaro
- Division of Pediatric Critical Care Medicine and Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan
| | - Hitesh S Sandhu
- University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
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Quinn RE, Riedl R, Rycus PT, Vogel TP, Silva-Carmona M, Anders MM, O'Neil ER. Extracorporeal Membrane Oxygenation Support for Interstitial Lung Disease in Idiopathic Inflammatory Myopathies: An ELSO Registry Analysis. ASAIO J 2023; 69:e96-e99. [PMID: 36228185 DOI: 10.1097/mat.0000000000001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Rachel E Quinn
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Ruth Riedl
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Peter T Rycus
- The Extracorporeal Life Support Organization, Ann Arbor, Michigan
| | - Tiphanie P Vogel
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Manuel Silva-Carmona
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Marc M Anders
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Erika R O'Neil
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Texas Children's Hospital, Houston, Texas
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Akkanti B, Suarez EE, O'Neil ER, Rali AS, Hussain R, Dinh K, Tuazon DM, MacGillivray TE, Diaz-Gomez JL, Simpson L, George JK, Kar B, Herlihy JP, Shafii AE, Gregoric ID, Masud F, Chatterjee S. Extracorporeal Membrane Oxygenation for COVID-19: Collaborative Experience From the Texas Medical Center in Houston With 2 Years Follow-Up. ASAIO J 2022; 68:1443-1449. [PMID: 36150083 DOI: 10.1097/mat.0000000000001791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Patients with severe refractory hypoxemic respiratory failure may benefit from extracorporeal membrane oxygenation (ECMO) for salvage therapy. The Coronavirus disease 2019 (COVID-19) pandemic offered three high-volume independent ECMO programs at a large medical center the chance to collaborate to optimize ECMO care at the beginning of the pandemic in Spring 2020. Between March 15, 2020, and May 30, 2020, 3,615 inpatients with COVID-19 were treated at the Texas Medical Center. During this time, 35 COVID-19 patients were cannulated for ECMO, all but one in a veno-venous configuration. At hospital discharge, 23 (66%) of the 35 patients were alive. Twelve patients died of vasodilatory shock (n = 9), intracranial hemorrhage (n = 2), and cannulation-related bleeding and multiorgan dysfunction (n = 1). The average duration of ECMO was 13.6 days in survivors and 25.0 days in nonsurvivors ( p < 0.04). At 1 year follow-up, all 23 discharged patients were still alive, making the 1 year survival rate 66% (23/35). At 2 years follow-up, the overall rate of survival was 63% (22/35). Of those patients who survived 2 years, all were at home and alive and well at follow-up.
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Affiliation(s)
- Bindu Akkanti
- From the Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
- The Center for Advanced Heart Failure, Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
| | - Erik E Suarez
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Erika R O'Neil
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Department of Critical Care, Texas Children's Hospital, Houston, Texas
| | - Aniket S Rali
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Rahat Hussain
- From the Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
- The Center for Advanced Heart Failure, Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
| | - Kha Dinh
- From the Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
- The Center for Advanced Heart Failure, Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
| | - Divina M Tuazon
- Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, Texas
| | | | - Jose L Diaz-Gomez
- Department of Anesthesia, Division of CV Anesthesia & Critical Care Medicine, Baylor College of Medicine, Houston, Texas
| | - Leo Simpson
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Joggy K George
- Department of Cardiology, Texas Heart Institute, Houston, Texas
| | - Biswajit Kar
- The Center for Advanced Heart Failure, Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
| | - J Patrick Herlihy
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Alexis E Shafii
- Department of Cardiovascular Surgery, Baylor St. Luke's Medical Center-Texas Medical Center, Houston, Texas
| | - Igor D Gregoric
- Division of Cardiothoracic Transplantation and Circulatory Support, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Faisal Masud
- Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, Texas
| | - Subhasis Chatterjee
- Department of Cardiovascular Surgery, Baylor St. Luke's Medical Center-Texas Medical Center, Houston, Texas
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
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Custer CM, O'Neil ER, Paskaradevan J, Rissmiller BJ, Gazzaneo MC. Children with Near-Fatal Asthma: The Use of Inhaled Volatile Anesthetics and Extracorporeal Membrane Oxygenation. Pediatr Allergy Immunol Pulmonol 2022; 35:170-173. [PMID: 36537704 DOI: 10.1089/ped.2022.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background and Purpose: The use of extracorporeal membrane oxygenation (ECMO) has been described for near-fatal asthma that continues to be refractory despite maximal medical therapy. Methods: Patients admitted to the pediatric intensive care unit at Texas Children's Hospital from 2012 to 2020 with the diagnosis of asthma who were supported on ECMO or isoflurane were included in the study. Patient demographics, medication usage, and complications were compared between the case group (ECMO, n = 12) and the control group (isoflurane only, n = 8). Results: All patients survived to discharge. ECMO patients received shorter durations of albuterol (12 versus 104 h, P = 0.0002) and terbutaline (13.3 versus 31.5 h, P = 0.0250). There were no differences in complication rates between the 2 groups. Conclusion: ECMO is a reasonable and safe support method for patients with near-fatal asthma and may lead to less bronchodilator medication exposure when compared with inhaled volatile anesthetic use.
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Affiliation(s)
- Chasity M Custer
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Erika R O'Neil
- Department of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Brian J Rissmiller
- Department of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Maria C Gazzaneo
- Department of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Pulmonology, Baylor College of Medicine, Houston, Texas, USA
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O'Neil ER, Quinn RE, Olson TL, Rycus PT, Anders MM, Chartan CA, Vogel TP, Silva-Carmona M, Coleman RD. Extracorporeal Membrane Oxygenation Support for Antineutrophil Cytoplasmic Antibody-associated Vasculitides: An ELSO Registry Analysis. ASAIO J 2022; 68:553-560. [PMID: 34324445 DOI: 10.1097/mat.0000000000001539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides with pulmonary involvement include granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis, and can present with life-threatening pulmonary hemorrhage in up to 40% of patients. Mortality in those patients who require intubation and mechanical ventilation can reach 77%. Extracorporeal membrane oxygenation (ECMO) can be used to support these patients through definitive diagnosis and treatment, although minimizing the risk of ventilator-induced lung injury. We aimed to determine factors associated with favorable outcomes in patients with (ANCA)-associated vasculitides supported on ECMO. We performed a retrospective observational study using the Extracorporeal Life Support Organization registry of pediatric and adult patients with ANCA-associated vasculitis supported on ECMO from 2010 to 2020. One hundred thirty-five patients were included for analysis. Many patients had renal involvement (39%) in addition to pulmonary involvement (93%). Survival was 73% in AAV patients supported on ECMO. The presence of pulmonary hemorrhage was not associated with worse outcomes in our cohort. Older age, the use of venoarterial ECMO, ECMO-cardiopulmonary resuscitation, or sustaining a cardiac arrest before ECMO was associated with decreased survival. In conclusion, venovenous ECMO should be considered as a supportive bridge to definitive diagnosis and treatment in (ANCA)-associated vasculitides, regardless if pulmonary hemorrhage is present.
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Affiliation(s)
- Erika R O'Neil
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Rachel E Quinn
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Taylor L Olson
- Children's National Hospital, Washington, District of Columbia
| | - Peter T Rycus
- The Extracorporeal Life Support Organization, Ann Arbor, Michigan
| | - Marc M Anders
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Corey A Chartan
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Tiphanie P Vogel
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Ryan D Coleman
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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O'Neil ER, Lin H, Shamshirsaz AA, Naoum EE, Rycus PR, Alexander PM, Ortoleva JP, Li M, Anders MM. Pregnant/Peripartum Women with COVID-19 High Survival with ECMO: An ELSO Registry Analysis. Am J Respir Crit Care Med 2021; 205:248-250. [PMID: 34767493 PMCID: PMC8787244 DOI: 10.1164/rccm.202109-2096le] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Erika R O'Neil
- Baylor College of Medicine Department of Pediatrics, 506057, Houston, Texas, United States;
| | - Huiming Lin
- Rice University, 3990, Statistics, Houston, Texas, United States
| | - Amir A Shamshirsaz
- Baylor College of Medicine, 3989, Department of Critical Care Medicine, Houston, Texas, United States.,Texas Children's Hospital, 3984, Department of Obstetrics and Gynecology, Houston, Texas, United States
| | - Emily E Naoum
- Massachusetts General Hospital, 2348, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, United States
| | - Peter R Rycus
- Extracorporeal Life Support Organization, Ann Arbor, Michigan, United States
| | - Peta Ma Alexander
- Children's Hospital Boston, 1862, Cardiology, Boston, Massachusetts, United States
| | - Jamel P Ortoleva
- Tufts Medical Center, 1867, anesthesiology and perioperative medicine, Boston, Massachusetts, United States
| | - Meng Li
- Rice University, 3990, Statistics, Houston, Texas, United States
| | - Marc M Anders
- Baylor College of Medicine Department of Pediatrics, 506057, Section of Critical Care Medicine, Houston, Texas, United States
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Olson TL, O'Neil ER, Kurtz KJ, MacLaren G, Anders MM. Improving Outcomes for Children Requiring Extracorporeal Membrane Oxygenation Therapy Following Hematopoietic Stem Cell Transplantation. Crit Care Med 2021; 49:e381-e393. [PMID: 33470779 DOI: 10.1097/ccm.0000000000004850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The objective of this study was to provide an updated review of survival for pediatric hematopoietic stem cell transplantation patients requiring extracorporeal membrane oxygenation therapy as well as characterize the demographics, clinical variables, and complications associated with mortality. DESIGN Retrospective database review of the Extracorporeal Life Support Organization Registry from 1990 to 2019. SETTING Extracorporeal membrane oxygenation centers reporting to Extracorporeal Life Support Organization. PATIENTS Patients treated with extracorporeal membrane oxygenation greater than 28 days to 18 years old with International Classification of Diseases Ninth Revision, International Classification of Diseases Tenth Revision, and current procedural terminology codes consistent with hematopoietic stem cell transplantation were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographics, year of extracorporeal membrane oxygenation run, clinical variables, comorbid diagnoses, and extracorporeal membrane oxygenation complications were assessed in relation to the primary study outcome of survival to hospital discharge. Ninety patients were included in the final analysis. The overall survival rate for the study period was 19%. However, the survival rate in the last decade (2010-2019) improved to 26% (p = 0.01; odds ratio 9.4 [1.2-74.8]). Factors associated with decreased survival included comorbid malignancy, elevated peak inspiratory pressure in conventionally ventilated patients, and pulmonary and metabolic complications on extracorporeal membrane oxygenation. CONCLUSIONS Pediatric patients posthematopoietic stem cell transplantation supported with extracorporeal membrane oxygenation have improving survival rates over time. With 26% of patients (16/62) surviving to hospital discharge in the last decade (2010-2019), history of hematopoietic stem cell transplantation may no longer be considered an absolute contraindication to extracorporeal membrane oxygenation. As advancements are made in hematopoietic stem cell transplantation therapies and extracorporeal membrane oxygenation management, the indications for life-saving extracorporeal membrane oxygenation support among patients posthematopoietic stem cell transplantation may expand accordingly.
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Affiliation(s)
- Taylor L Olson
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Erika R O'Neil
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kristen J Kurtz
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Hospital, Singapore
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Marc M Anders
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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Abstract
INTRODUCTION Dual-lumen cannulas were designed to provide venovenous extracorporeal membrane oxygenation (VV ECMO) with single-vessel access. Anatomic and size considerations may make appropriate placement challenging in children. Dual-lumen cannulas are repositioned in 20-69% of pediatric patients, which can be difficult without transient discontinuation of ECMO support. METHODS We repositioned three dual-lumen ECMO cannulas introduced via the right internal jugular vein using a transfemoral snare technique under real-time ultrasound and fluoroscopy. RESULTS Two of three patients were supported on VV ECMO and one on veno-veno-arterial (VV-A) ECMO. Two of the three patients had their dual-lumen cannula repositioned under ultrasound and fluoroscopy guidance and one was repositioned just with ultrasound. No patient experienced a complication from the transfemoral snare technique such as femoral hematoma, hemorrhage or limb ischemia. CONCLUSION We describe three patients who successfully had dual-lumen cannulas repositioned without cessation of ECMO using a transfemoral "lasso" technique.
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Affiliation(s)
- Erika R O'Neil
- Department of Pediatrics, Section of Critical Care, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Ryan D Coleman
- Department of Pediatrics, Section of Critical Care, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Adam M Vogel
- Department of Pediatrics, Section of Critical Care, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.,Division of Pediatric Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Corey A Chartan
- Department of Pediatrics, Section of Critical Care, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Kamlesh U Kukreja
- Division of Interventional Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
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Olson TL, O'Neil ER, Ramanathan K, Lorusso R, MacLaren G, Anders MM. Extracorporeal membrane oxygenation in peripartum cardiomyopathy: A review of the ELSO Registry. Int J Cardiol 2020; 311:71-76. [PMID: 32321653 DOI: 10.1016/j.ijcard.2020.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/23/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
AIMS Data on the use of extracorporeal membrane oxygenation (ECMO) for cardiogenic shock in peripartum cardiomyopathy (PPCM) is limited. We queried the Extracorporeal Life Support Organization (ELSO) Registry for PPCM patients treated with ECMO in order to characterize demographic and clinical features, complications, survival, and variables associated with mortality. METHODS AND RESULTS This was a retrospective review of patients voluntarily entered into the ELSO Registry. De-identified data was collected on patients with a diagnosis of PPCM based on ICD-9/ICD-10 coding who received ECMO between 2007 and 2019. Collected data included demographics, ECMO mode, cannulation strategies, pre-ECMO ventilator, biochemical, and hemodynamic parameters, run duration, complications, and survival to wean off ECMO and hospital discharge. Our primary outcome measure was survival to discharge. In the final analysis, 88 veno-arterial (VA) ECMO patients were included. Overall, 72% of patients were weaned off ECMO, including 10% who were weaned to ventricular assist device or heart transplantation, and 64% survived to hospital discharge. Extracorporeal cardiopulmonary resuscitation (ECPR) was performed in 11% of patients with 60% survival. Factors associated with decreased survival included neurologic complications (p = 0.03), specifically central nervous system hemorrhage (p = 0.01). CONCLUSION Our review is the largest to date of PPCM patients supported with VA ECMO for cardiogenic shock. ECMO and ECPR are valuable forms of short-term mechanical circulatory support with acceptable mortality profiles for PPCM patients who remain refractory to aggressive medical management. Complications should be meticulously avoided, especially neurologic complications.
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Affiliation(s)
- T L Olson
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - E R O'Neil
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - K Ramanathan
- Cardiothoracic Intensive Care Unit, National University Hospital, Singapore
| | - R Lorusso
- Cardio-Thoracic Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - G MacLaren
- Paediatric Intensive Care Unit, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | - M M Anders
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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