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2. Extracorporeal Life Support Organization Registry International Report 2022: 100,000 Survivors

Author

Tonna, Joseph E., Boonstra, Philip S., MacLaren, Graeme, Paden, Matthew, Brodie, Daniel, Anders, Marc, Hoskote, Aparna, Ramanathan, Kollengode, Hyslop, Rob, Fanning, Jeffrey J., Rycus, Peter, Stead, Christine, Barrett, Nicholas A., Mueller, Thomas, Gómez, Rene D., Malhotra Kapoor, Poonam, Fraser, John F., Bartlett, Robert H., Alexander, Peta M.A., Barbaro, Ryan P., Abbasi, Adeel, Said Abdalmohsen, Ahmad, Abdelbary, Akram M., Abecasis, Francisco, Abel, Peter, Abu-Omar, Yasir, Adams, Douglas R, Manuel Africano, Juan, Aganga, Devon, Agati, Salvatore, Agerstrand, Cara, Aguillon, Mario V., Akers, Crystal S., Akhtarekhavari, Julia, Alazzam, Mohammad Izzat Salah, Albert, Martin, Alberti, Angela, Al-Fares, Abdulrahman A., Alfoudri, Huda, Allaert, Silvie, Allbert, Keesha N., Allen, Christopher T., Lescano Alva, Miguel Ángel, Alwardt, Cory M., Amigoni, Angela, Anandamurthy, Balaram, Anastasiadis, Kyriakos, Anders, Nicholas R., Anderson, Scott A., Anderson, Patricia L., Andrijević, Ana, Annoni, Alice, Anselmi, Michael, Anstey, James R., Antonini, Marta V., Antonitsis, Polychronis, Stein Araujo, Tays, Arcalas, Rhodney, Areinamo, Igor, Martin Arias, Anibal, Armijo-Garcia, Veronica, Aronsky, Vladimir, Arora, Lovkesh, Arora, Madhur, Leigh Aspenleiter, Marit, Atik, Fernando A., AugustGeorg Auzinger, Erin Colleen, Azzam, Ismail, Bacchetta, Matthew, Bak, Erica I., Balcells, Joan, Sánchez Ballesteros, Jesús, Banjac, Igor S., Barbaria, Jacqueline M., Barrigoto, Cleide L., Bass, Stephanie D., Batranović, Uroš, Bauer, Matthew H., Fernando Bautista, Diego, Beck, Robert M., Giraldo Bejarano, Estefania, Belohlavek, Jan, Bembea, Melania M., Benes, Jan, Benharash, Peyman, Benish, Lynne A., Bennett, Suzanne, Bento, Luís F.N., Bermudez, Christian A., Bertini, Pietro, Best, Derek, Bharat, Ankit, Bhutta, Omar J., Bizzell, Samantha J., Blakeman, Stephanie A., Blanco-Schweizer, Pablo, Blanton, Jessica K., Blood, Peggy S., Bohlmann, Allison S., Kyle Bohman, John, Bombino, Michela, Kathleen Bonadonna, Desiree, Bond, Ashley, Borgmann, Kristina M., Bourgoin, Pierre, Boville, Brian M., Boza, Raquel, Brady, Heather L., Brady, Alison, Braunlich, Jessica M., Bridges, Brian C., Brinkley, Karen K., Brookshire, Robert S., Brozzi Nicole Brueggemann, Nicolas A., Buckley, Dwight P., Jr., Buckley, Klayton, Budhani, Irfan B., Bukamal, Nazar, Burgos, Lucrecia M, Burša, Filip, Busby, Landon K., Buscher, Hergen, Butler, Menoly, Butt, Warwick W., Byrnes, Jonathan W., Calaritis, Christos, Caldwell, Lisa R., Calligaro, Gregory L., Campbell, Patrick T., Camporota, Luigi, Fernando Caneo, Luiz, Jovo Carapic, Vladimir, Carrasco-Carrasco, Cristina, Ivan Carrizo, Nestor, Carrow, Heidi, Carton, Edmund G., Casabella, Christian, Gomez Casal, Vanesa, Casey, Francis L., III, Castillo, Andres, Castleberry, Anthony W., Alexandros Cavayas, Yiorgos, Cerqua, Karey, Ming Chan, Kai Man ChanWai, Brian Chapman, Jason, Brahma Chari, Hari, Cheifetz, Omair ChaudharyIra M., Chen, Robin H.S, Chen, Weiting, Cheung, Eva W., Cheung, Anson, Chico, Juan I., Chiletti, Roberto, Jin Cho, Hwa, Cholette, Jill M., Christensen, Steffen, Chui, Betty S., Circelli, Alessandro, Clement, Katherine C., Cleuziou, Julie, Clouse, Brian, Cole, Gwendolen, Coles, Garrett M., Collins, Monika F., Collins, Monika F., Connelly, James, Conrad, Steven A., Cook, Marlene, Copeland, Hannah, Copus, Scott C., Cox, Charles S., Jr, Craig, Lynne K., Crain, Natasha, Cremonese, Ricardo V., Criswell, Emily A., Cross, Lisa M., Crowley, Moira A., Crowley, Jerome C., Cruz, Leonora, Cypel, Marcelo, Czarnik, Tomasz, Czuczwa, Miroslaw E., Sica da Rocha, Taís, Daddow, Samuel, Dali, Dante C., Dalton, Heidi J., Daly, Kathleen J.R., Damuth, Emily, Daniel, Dennis A., Daniel IV, John M., Daniel, Josiane M., Danis, Max D., Danko, Melissa E., Rodrigues Dantas, Joao Alberto, Daoust, Isabelle, Dauwe, Dieter F., Davidson, Mark, Davis, Joel C., Davis, Mitchell, D’Cunha, Jonathan, de Arruda Bravim, Bruno, de BoodeKim T. De La Cruz, Willem P., Gray DeAngelis, Kathryn, Debeuckelaere, Gerdy, Deitemyer, Matthew A., DellaVolpe, Jeffrey, Deneau, Jamie L., DeNino, Walter F., Denmark, Christopher G., Denney, Derek, DeValeria, Patrick A., Dewulf, Petra, Di Nardo, Matteo, DiBardino, Daniel J., DiMartino, Joseph, Dimopoulos, Stavros, Domico, Michele B., Dominy, Meaghan E., Donker, Dirk W., Dresbach, Till, Droogh, Joep M., Dunlap, Tiffany W., Dupon, Allsion, Durham, Lucian A., III, Durward, Andrew, Dvorak, Anna, Dyett, John F., Dziedzina, Carol L., Eaken, Carmen L., Eaton, Jonathan S., Eberle, Christopher J., Edwards, Linda, Efseviou, Christakis, Eigner, Juliann M., Ahmed Elhamrawi, Hazem, Elhazmi, Alyaa M., Elizondo, Tammy, Ellersick, Beverly L., Emling, Jonathan A., Ernst, Andreas, Pablo Escalante, Juan, Espinoza, Otoniel, Evey, Lee W., Fan, Eddy, Fang, Gary, Faulkner, Gail M., Fauman, Karen R, Ferguson, Niall, Ferreira, Benigno, Fiane, Arnt E., Andrade Fierro, Dario, Martha Filippi, María, Findeisen, Michael C., Finlay, Katie, Finlayson, Gordon, Fischer, Gwenyth A., Fischer, Courtney D., Fischer, William J., III, Fisher, Caleb M., Fitriasari, Reni, Fitzgerald, Jillian, Fix, Melissa K., Fleming, Sarah B., Flynn, Brigid C., Forst, Beth A., Fortuna, Philip P., Foti, Giuseppe, Fox, Matthew P., Franco, Thais O., David Freeland, C., Fried, Justin A., Friedman, Matthew L., Furlanetto, Beatriz, Fux, Thomas, Gaião, Sérgio, Gale, Michael J., Garcia, Joann Kathleen G., Garcia-Montilla, Romel, Gardner, Eric R., Garg, Meena, Garrison, Lawrence L., Gavrilovic, Srdjan M., Gawda, Ryszard, Geer, Laura W., Gelandt, Elton A., Gelvin, Michael G., Genovese, Bradley M., George, Jeffrey A., George, Timothy J, George, Sangley, Ghimire, Anup, Giani, Marco, Gill, Baljit S., Glikes, Erin, Golecki, Michael, Gongora, Enrique, Govener, Sara, Graf, Amanda, Grasselli, Giacomo, Gray, Brian W., Greenlee, Joseph A., III, Gregoric, Igor D., Gregory, Melinda, Grins, Edgars, Volker Groesdonk, Heinrich, Group, Kimberly F., Guarracino, Fabio, Joy Guidi-Solloway, Alexandra, Gunn, Tyler M., Guru, Pramod K, Haddle, John C., Haft, Jonathan W., Haisz, Emma, Hall, Julie L., Hall, Cameron, Hamaguchi, Jun, Hammond, Terese C., Han, Peggy K., Hardison, Daphne C., Harischandra, Dickwelle T., Hart, Shaun M., Harting, Matthew T., Hartley, Louise, Harvey, Chris J., Hasan, Zubair, Fawzy Hassan, Ibrahim, Hastings, Jennifer R., Hatcher, Renee’, Hatton, Kevin W., Haught, Christopher K., Awori Hayanga, Jeremiah, Peter Haydon, Timothy, Healy, Aaron H., Heard, Micheal L., Heather, Beth M., Hendrix, Rik H.J., Hennig, Felix, Hermens, Greet HermansJeannine A.J., Hernandez, Deborah A., Hernandez-Montfort, Jaime, Herrera, Guillermo, Hickman, Keri, Hittel, Ashley, Hobbs, Crystal, Hoffman, Jordan R.H., Hollinger, Laura E., Homishak, Michael, Horigoshi, Nelson K., Hoshino, Kota, Huang, Shu-Chien, Huenges, Katharina, Hussey, Alexander D., Hyslop, Robert W., Ihle, Rayan E., Ingemansson, Ola, Ivulich, Daniel, Jackson, Amanda L., Garcia Jacques, Rogelio, Jain, Harsh, Jakobs, Sharon M., Jan, Robert, Janowiak, Lisa M., Jara, Claire B., Jarden, Angela M., Jarzembowski, Jamie L., Jaudon, Andrew, Kishore Jayanthi, Venkata Krishna, Jennings, Joseph A., Jeong, Inseok, Meza Jiménez, Rafael, Jimenez-Rodriguez, Gian M., Joachim, Sabrina, Joelsons, Daniel, Johnson, Caroline A., Johnson, Andrea L., Jones, Jeffry H., Joseph, Mark, Joseph, Sunimol, Joshi, Raja, Joyce, Christopher J., Seung Jung, Jae, Carone Junior, José, Kallas, Harry J., KamerkarPilje Kang, Asavari, Kar, Biswajit, Karapanagiotidis, Georgios T., Kattan, Javier, Kaufman, David A., Kawauchi, Akira, Keene, Sarah D., Keller, Norma M., Keller, Roberta, Kelley, Emily W., Kelley, Kellie, Kelly-Geyer, Janet F., Kenderessy, Peter, Kenny, Laura E., Keshavjee, Shaf, Kessel, D., Kessler, Heather, Keuler, Suzanne, Khicha, Sanjay, Wan Kim, Do, Kim, Richard Y., Maxwell Kime, Aaron, Kincade, Robert C., Kipfmueller, Florian, Kirk, Douglas A., Klein, Liviu, Knapp, Randall S., Knapp, Randall S., Kneyber, Martin C.J., Knowles, Andrea L., Koch, Jillian M., Koepke, Stephanie, Kogelmann, Klaus M., Elzo Kraemer, Carlos, Krauklis, Amanda, Krumroy, Samantha L., Kumar, Madhan, Kumar, Arun, Kumpf, Matthias E, Kyle, Kimberly, Laffin, Anna, Kees Lagrand, Wim, Lahiji, Parshawn A., Keung Lai, Peter Chi, Ka Lai, Cally Ho, Danielle Laird, Amanda, Landsberg, Michelle LaMarreDavid M., Lanmueller, Pia, Oude Lansink-Hartgring, Annemieke, Beth Larson, Sharon, Laufenberg, De’Ann M., Lavana, Jayshree, Layne, Tracie L., John Lazar, Michael, Ledoux, Matthew R., Lee, Raymond C., Leek, Thomas M., Lequier, Laurance, Lesbekov, Timur, Leslie, Robert, Anne Leung, Kit Hung, Lillie, Jon, Phang Lim, Yeong, Lim, Sang-Hyun, Lin, Ling, Lindsey, Thomas, Ho Ling, Steven Kin, Lingle, Kaitlyn J., Lipes, Jed, Liu, Songqiao, Llevadias, Judit, Lomas, Erin A., Longenecker, Robert D., Lorusso, Roberto, Ann Low, Tracy, Steven Lubinsky, Anthony, Lucas, Matthias LubnowMark T., Lucchini, Alberto, Luze, Lisa E., Lynch, William R., Manoj, M.C., Maas, Jacinta J., MacNamara, Vanessa, Madden, Jesse L., Maimone, Justin, Malhotra, Rajiv, Malone, Matthew P., Mangukia, Chirantan, Manzur-Sandoval, Daniel, Maráczi, Veronika, Marinaro, Jonathan L., Marinucci, Christina R., Marshall, Tammy, Martin, Mark, Marwali, Eva M., Maslach-Hubbard, Anna, Matijašević, Jovan, Mattke, Adrian, Mattucci, Joseph, Maul, Timothy M., Maybauer, Marc O., Mayette, Michael, Mayville, Joni R., McAllister, Catherine, McBride, Martha W., Scott McCaul, David, McClelland, Samantha L.S., Gregory McCloskey, Colin, McGregor, Randy, McKamie, Wesley A., McKee, Andrew D., McMahon, Chelsea M., McMullin, Kaye, McNicol, Jane, McNulty, John P., McRae, Thomas, Meade, Maureen E., Meersseman, Philippe, Mekeirele, Michael, Ito Mendes, Elisa, Menon, Anuradha P., Meyer, Jason P., Meyers, Jourdan E., Meyns, Bart, Mignone, John L., Miller, Brittany D., Miller, Malcolm G.A., Miller, Deborah, Mintak, Renee, Minter, Sarah M., Reis Miranda, Dinis, Mirza, Farrukh, Mishkin, Joseph D., Modelewski, Paul, Mohan, Rajeev C., Hui Mok, Yee, Money, Dustin, Monteagudo, Julie, Moores, Russell R., Jr., Moran, Patrick, Morelock, Shawn, Moreno, Marsha R., Blanco Morillo, Juan, Morrison, Tracy, Morton, John M., Morton, Brenda, Moscatelli, Andrea, Mosier, Jarrod M., Muellenbach, Ralf M., Mueller, Andreas, Mueller, Dale, Musca, Steven C., Nagpal, Dave, Najaf, Tasnim, Narasimhan, Mangala, Nater, Melissa, Natividad, Zynthia, Nedeljkov, Djordje, Nelson, Bryan D., Newman, Sally F., Newton, Debra E., Neyman, Jonathan L., George Ng, Wing Yiu, Nicholson, Meghan C., Nicolaas, Christine, Nix, Charlie, Nkwantabisa, Raymond, Nolan, Shirley, Norese, Mariano, Norton, Bridget M., Norton, Bridget M., O’Brien, Serena G., O’Callaghan, Maura, Oishi, Peter, O’Leary, Tony D., Olia, Salim E., O’Meara, Carlisle, Oppel, Emily E., Arias Ortiz, Julian, Oza, Pranay L., Ozment, Caroline P., Pacific, Marjorie, Pálizas, Fernando, Palmer, David, Paoletti, Luca, Pardo, Diego H., Paredes, Pablo, Patel, Thomas PasgaardMrunal G., Patel, Sandeep M., Patel, Vijay S., Patel, Brijesh V., PatelDrisya Paul, Sameer, Pawale, Amit A., Pearson, Nicole M., Renee Pearson, Crystal, Peek, Giles J., Pellecchia, Crescens M., Pellegrino, Vincent, Peperstraete, Harlinde, Perkins, Rebecca L., Perkins, Brandon, Peterec, Steven, Peterman, Claire, Phillips, Cooper W., Piekutowski, Richard R., Pilan, María L., Luisa Pilan, Maria, Mark Pincus, Jason, Pino, Melissa, Plambeck, Robert W., Plisco, Michael S., Plumley, Donald A., Plunkett, Mark D., Poffo, Robinson, Poh, Pei-Fen, Polito, Angelo, Pollema, Travis L, Pozzi, Matteo, Pozzi, Matteo, Pranikoff, Thomas, Prekker, Matthew E., Prossen, Erik F., Puligandla, Pramod S., Puslecki, Mateusz, Raheel Qureshi, Muhammad, Emilia Rabanal, Lily, Abdulhamid Rabie, Ahmed, Rackley, Craig R., Radovancevic, Rajko, Raes, Matthias, Allen Raff, Lauren Desiree, Rahban, Youssef, Raimer, Patricia L., Rajbanshi, Bijoy G., Ramanan, Raj, Rambaud, Jerome, Ramírez-Arce, Jorge A., Simões Ramos, Ana Carolina, Rao, Suresh G., Rector, Raymond, Redfors, Bengt, Regmi, Ashim, Alejandro Rey, Jose, Miguel Ribeiro, Joao, Richards, Chelsea E, Joan Richardson, C., Riddle, Christy C., Riera, Jordi, Ripardo, Marina, Rivas, Fernando M., Roan, Ronald M., Robertson, Elizabeth, Robinson, Megan, Röder, Daniel, Rodrigus, Inez E.R., Paul Roeleveld, Peter, Romano, Jennifer C., Rona, Roberto, Ann Rosenberg, Carol, Rosenow, Felix, Rowe, Robert J., Rower, Katy E., Rudolph, Kristina L., Fernando Rueda, Luis, Ruf, Bettina, Russell, Hyde M., Russell, Nichole, Ryan, Kathleen, Saberi, Asif A., Said, Ahmed S., Sailor, Caitlin, Sakal, Angela, Lujan Salas, Gisela, Salazar, Leonardo, Saleem, Kashif, Samoukovic, Gordan, Sanchez, Pablo G., Marie Santiago, Lian, Sargin, Murat, Miguel Sassine, Assad, Satou, Nancy L., Saunders, Paul C., Schachinger, Scott, Schaible, Thomas, Schellongowski, Peter, Schlager, Gerald W., Schmid, Christof, Schmitt, Joachim, Schnell, LeeAndra, Schnur, Janos, Schroeder, Lukas, Schubach, Scott, Schuetz, Michael T., Schwartz, Gary S., Schwarz, Patricia, Scriven, Nicole M., Seabrook, Ruth B., Seefeldt, Cassandra, Seelhammer, Troy G., Segura-Matute, Susana, Sen, Ayan, Adrian Seoane, Leonardo, Shaffer, Jamie, Shafi, Bilal M., Shambley, Shannon, Shankar, Shyam, Shapland, Amanda, Sharng, Yih, Shavelle, David, Sheldrake, Jayne, Mohan Shetty, Rajesh, Shiber, Joseph R., Shimzu, Naoki, Lou Short, Billie, Sichting, Kay A., Sidehamer, Keith E., Siebenaler, Teka, Silvestry, Scott C., Sinclair, Jennifer T, Sinclair, Andrew, Singh, Aalok R., Singh, Gurmeet, Skinner, Sean C., Smart, Alexandra, Smith, Reanna M., Smith, Adam, Smith, Karen, Sommer-Candelario, Sherri, Song, Seunghwan, Sorensen, Gro, Sousa, Eduardo, Sower, Christopher T., Spadea, Nicholas V, Spangle, April, Speicher, David G., Spieth, Peter M., Srivastava, Ankur, Srivastava, Neeraj, Stahl, Mark, Stallkamp, Eric D., Jr, Stanley, Vanessa J., Starr, Joanne P., Staudinger, Thomas, Stevens, Berkeley E., Stevens, Kimberly, Stocker, Christian, Strickland, Richard, Suarez, Erik E., Kumar Subramanian, Rakesh, Sudakevych, Serhii, Summerall, Charlene, Sundararajan, Santosh, Susupaus, Attapoom, Suzuki, Hiroyuki, Sweberg, Todd, Sydzyik, Troy, Anh Ta, Tuan, Tagliari, Luciana, Tanaka, Hiroyuki, Tanski, Christopher T., Tasset, Mark, Taylor, Donna M., Teman, Nicholas R., Ramesh Thangaraj, Paul, Thiagarajan, Ravi R., Thiruchelvam, Timothy, Thomas, James A., Thomas, Owain D., Thompson, Shaun L., Thomson, David A., Thukaram, Roopa, Todd, Mark L., Toeg, Hadi, Torres, Silvio F., Trautner, Simon, Trombino, Terry, Tuazon, Divina M., Tuel, Julie, Tukacs, Monika, Turner, April N., Tyree, Melissa M., Uchiyama, Prashant Vaijyanath, Makoto, van den Brule, Judith M.D., van Dyck, Marlice A., van Gijlswijk, Mascha, Van Meurs, Krisa P., VanDyck, Tyler J., Vardi, Amir, Vega, Alejandra, Ventetuolo, Corey E., Vera, Magdalena, Vercaemst, Leen, Vets, Philippe, Viamonte, Heather, Vidlund, Mårten, Vitali, Sally H., Vlaa, Alexander P.J., Vuylsteke, Alain, Loon Wan, Kah, Watkins, Reuben, Watson, Pia, Weast, Travis A., Weaver, Karen E., Welkovics, Norbert, Wellner, Heidi L., Wells, Jason C., Welter, Karen, Westpheling, Amber G., Whalen, Lesta D.S., Whebell, Stephen, Wiersema, Ubbo, Wiisanen, Matthew E., Eugene Wilcox, Bradley, Wille, Keith, Jan Will, Ellyne, Wilson, Brock J., Win, April M., Winearls, James R., Wise, Linda J., Witter, Tobias, Ruby Wong, Hoi Mei, Worku, Berhane, Wright, Tina M, Wu, James K., Yalon, Larissa A., Yantosh, Garrett, Yaranov, Dmitry M., Yee, Pat, Yi, Cassia, Yost, Christian C., Young, John, Younger, Katrina, Zaborowski, Steven, Zachmann, Brenda, Zainab, Asma, Zanai, Rosanna, Zhao, Ju, Zhou, Chengbin, and Zinger, Marcia

Published
2024
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3. Factors XI and XII in extracorporeal membrane oxygenation: longitudinal profile in children

Author

Drop, Joppe, Letunica, Natasha, Van Den Helm, Suelyn, Heleen van Ommen, C., Wildschut, Enno, de Hoog, Matthijs, van Rosmalen, Joost, Barton, Rebecca, Yaw, Hui Ping, Newall, Fiona, Horton, Stephen B., Chiletti, Roberto, Johansen, Amy, Best, Derek, McKittrick, Joanne, Butt, Warwick, d’Udekem, Yves, MacLaren, Graeme, Linden, Matthew D., Ignjatovic, Vera, Attard, Chantal, and Monagle, Paul

Published
2023
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5. Why do children not survive extracorporeal membrane oxygenation?

Author

Alexander, Georgina K, Namachivayam, Siva P, Chiletti, Roberto, and Butt, Warwick

Subjects
CRITICALLY ill children, EXTRACORPOREAL membrane oxygenation, CHILD mortality, PROGNOSIS, BRAIN death
Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is used in critically ill children with cardiac and/or respiratory failure. Use is increasing in children with high‐risk comorbidities. Reasons children do not survive ECMO are poorly described. Aims: Describe characteristics and cause of death, compare mortality in children with high‐risk comorbidities, evaluate mortality trends over a decade. Method: All children <18 years old who received ECMO at this institution from 1 January 2011 to 31 December 2020 were described and categorised by outcome: died on or <48 h post‐ECMO, died ≥48 h post‐ECMO, survived to hospital discharge. Children who did not survive ECMO (DNSE) were categorised to: ECMO withdrawal for irrecoverable original condition, withdrawal for poor prognosis neurological condition, brain death, withdrawal for poor prognosis with multiple complex conditions, and unsupportable. Poison regression was used to analyse survival trends. Results: Four hundred twenty‐eight children received ECMO, 19% DNSE, 14% died ≥48 h post‐ECMO and 67% survived. ECMO was electively withdrawn for irrecoverable original condition (39%), poor prognosis for neurological condition (32%) or multiple complex conditions (18%). One hundred twenty‐two children had ≥1 high‐risk comorbidity. Children with genetic syndromes (58%), risk‐adjusted congenital heart surgery score‐1 ≥4 (53%), primary immunodeficiency (50%) had lower hospital survival. No children with malignancy/bone marrow transplant survived to hospital discharge. Overall hospital survival was 67%, with no significant change during the study period (P‐trend = 0.99). Conclusion: Children who DNSE have therapy electively withdrawn for irrecoverable disease or poor prognosis. Children with high‐risk comorbidities have a reasonable chance of survival. This study informs clinicians ECMO may be a therapeutic option. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Definitions of adverse events associated with extracorporeal membrane oxygenation in children: results of an international Delphi process from the ECMO-CENTRAL ARC

Author

Alexander, Peta M A, Di Nardo, Matteo, Combes, Alain, Vogel, Adam M, Antonini, Marta Velia, Barrett, Nicholas, Benedetti, Giulia M, Bettencourt, Amanda, Brodie, Daniel, Gómez-Gutiérrez, René, Gorga, Stephen M, Hodgson, Carol, Kapoor, Poonam Malhotra, Le, Jennifer, MacLaren, Graeme, O’Neil, Erika R, Ostermann, Marlies, Paden, Matthew L, Patel, Neil, Rojas-Peña, Alvaro, Said, Ahmed S, Sperotto, Francesca, Willems, Ariane, Vercaemst, Leen, Yoganathan, Ajit P, Lorts, Angela, del Nido, Pedro J, Barbaro, Ryan P, Abecasis, Francisco, Al Foudri, Huda, Anders, Marc M., Angus, Derek C., Annich, Gail M., Arachchillage, Deepa J., Akcan-Arikan, Ayse, Armstrong, Aimee K., Balcells, Joan, Barrett, Meredith, Bartlett, Robert H., Belda-Hofheinz, Sylvia, Bembea, Melania M., Best, Derek J., Bonadonna, Desiree, Boonstra, Philip S., Brogan, Thomas V, Brown, Katherine L, Butragueño-Laiseca, Laura, Butt, Warwick W., Camporota, Luigi, Cardenas, Barbara, Cascarano, Maria T., Caspi, Joseph, Chen, Eric, Chiletti, Roberto, Colombo, Giovanna G., Conte, Marisa L., Crowe, Liz, Cvetkovic, Mirjana, Dalton, Heidi J., Daverio, Marco, Davidson, Mark G., Davis, Carl, DiGeronimo, Robert J., Egbunine, Ariel, Ellis, W. Cory, Fan, Eddy, Foster, Claire C, Fraser, John F., Friedman, Matthew L., Furlong-Dillard, Jamie, Fynn-Thompson, Francis, Garcia, Alejandro V., Geppert, Jeffery, Gillette, Nicole, Grazioli, Lorenzo, Greene, Christina L, Guerguerian, Anne-Marie, Guilliams, Kristin P., Haji Fortis, Jumana Y., Hao, Jianming, Heinsar, Silver, Hejduk, Mark W., Himebauch, Adam S., Horvat, Christopher M., Hoskote, Aparna, Hou, Xiaotong, Hyslop, Robert W., Ibrahim, Nicole, Ito, Takuya, Karagiannidis, Christian, Karam, Oliver, Kaushik, Shubhi, Kilbaugh, Todd J., Kim-Campbell, Nahmah, Kirsch, Roxanne E, Kormos, Robert L., Kornberger, Angela, Krucoff, Mitchell W., Lakshminrusimha, Satyan, LaRovere, Kerri L, Leger, Pierre-Louis, Levy, Philip T., Lorusso, Roberto, Lyster, Haifa, Malone, Matthew P., McMullan, D. Michael, Mečířová, Soña, Mehran, Roxana, Merz, Scott I., Mochizuki, Shuichi, Moler, Frank W., Molla, Kalkidan, Monagle, Paul, Morgan, Gareth J., Morgan, Catherine, Morice, Marie-Claude, Muszynski, Jennifer A., Najaf, Tasnim A., Nellis, Marianne E., Newburger, Jane W., O'Rourke, P. Pearl, Ostadal, Petr, Ozment, Caroline P., Pagani, Francis D., Peek, Giles J., Polito, Angelo, Priest, John R., Raman, Lakshmi, Rintoul, Natalie E., Roy, Nathalie, Rubin, Juli, Rumford, Martha, Rycus, Peter, Ryerson, Lindsay M., Sakamoto, Wakako, Segura-Matute, Susana, Shekar, Kiran, Spinella, Philip C., Spitzer, Ernest, Starr, Joanne P., Stead, Christine, Steffen, Katherine, Steiner, Marie E., Tan, Lucy, Tasker, Robert C., Taylor, J. Michael, Thiagarajan, Ravi R., Tonna, Joseph E., Ubertini, Gina M., van Leeuwen, Grace, Vang, Eric, Ventetuolo, Corey E., Venugopal, Prem S., Weinberg, Allison, Westrope, Claire, Wu, Changfu, Wylie, Gillian, Zeymer, Uwe, Zivick, Elizabeth E., and Zochios, Vasileios

Abstract

Extracorporeal membrane oxygenation (ECMO) is a high-risk and low-volume life support with increasing clinical study. However, heterogenous outcome definitions impede data assimilation into evidence to guide practice. The Academic Research Consortium (ARC), an international collaborative forum committed to facilitating the creation of stakeholder-driven consensus nomenclature and outcomes for clinical trials of medical devices, supported the ECMO Core Elements Needed for Trials Regulation And quality of Life (ECMO-CENTRAL) ARC. The ECMO-CENTRAL ARC was assembled to develop definitions of paediatric ECMO adverse events for use in clinical trials and regulatory device evaluation. An initial candidate list of ECMO adverse events derived from the mechanical circulatory support ARC was supplemented with a review of ECMO-relevant adverse event definitions collated from literature published between Jan 1, 1988, and Feb 20, 2023. Distinct teams of international topic experts drafted separate adverse event definitions that were harmonised to existing literature when appropriate. Draft definitions were revised for paediatric ECMO relevance with input from patients, families, and an international expert panel of trialists, clinicians, statisticians, biomedical engineers, device developers, and regulatory agencies. ECMO-CENTRAL ARC was revised and disseminated across research societies and professional organisations. Up to three rounds of internet-based anonymous surveys were planned as a modified Delphi process. The expert panel defined 13 adverse event definitions: neurological, bleeding, device malfunction, acute kidney injury, haemolysis, infection, vascular access-associated injury, non-CNS thrombosis, hepatic dysfunction, right heart failure, left ventricular overload, lactic acidaemia, and hypoxaemia. Definitional structure varied. Among 165 expert panel members, 114 were eligible to vote and 111 voted. Consensus was achieved for all proposed definitions. Agreement ranged from 82% to 95%. ECMO-CENTRAL ARC paired rigorous development with methodical stakeholder involvement and dissemination to define paediatric ECMO adverse events. These definitions will facilitate new research and the assimilation of data across clinical trials and ECMO device evaluation in children.

Published
2024
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10. Individualized vancomycin dosing in infants: prospective evaluation of an online dose calculator

Author

Wilkins, Amanda L, primary, Lai, Tony, additional, Zhu, Xiao, additional, Bolisetty, Srinivas, additional, Chiletti, Roberto, additional, Cranswick, Noel, additional, Gardiner, Kaya, additional, Hunt, Rodney, additional, Malhotra, Atul, additional, McMullan, Brendan, additional, Mehta, Bhavesh, additional, Michalowski, Joanna, additional, Popat, Himanshu, additional, Ward, Meredith, additional, Duffull, Stephen, additional, Curtis, Nigel, additional, and Gwee, Amanda, additional

Published
2023
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11. Factors XI and XII in extracorporeal membrane oxygenation:longitudinal profile in children

Author

Drop, Joppe, Letunica, Natasha, Van Den Helm, Suelyn, Heleen van Ommen, C., Wildschut, Enno, de Hoog, Matthijs, van Rosmalen, Joost, Barton, Rebecca, Yaw, Hui Ping, Newall, Fiona, Horton, Stephen B., Chiletti, Roberto, Johansen, Amy, Best, Derek, McKittrick, Joanne, Butt, Warwick, d'Udekem, Yves, MacLaren, Graeme, Linden, Matthew D., Ignjatovic, Vera, Attard, Chantal, Monagle, Paul, Drop, Joppe, Letunica, Natasha, Van Den Helm, Suelyn, Heleen van Ommen, C., Wildschut, Enno, de Hoog, Matthijs, van Rosmalen, Joost, Barton, Rebecca, Yaw, Hui Ping, Newall, Fiona, Horton, Stephen B., Chiletti, Roberto, Johansen, Amy, Best, Derek, McKittrick, Joanne, Butt, Warwick, d'Udekem, Yves, MacLaren, Graeme, Linden, Matthew D., Ignjatovic, Vera, Attard, Chantal, and Monagle, Paul

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is used in children with cardiopulmonary failure. While the majority of ECMO centers use unfractionated heparin, other anticoagulants, including factor XI and factor XII inhibitors are emerging, which may prove suitable for ECMO patients. However, before these anticoagulants can be applied in these patients, baseline data of FXI and FXII changes need to be acquired. Objectives: This study aimed to describe the longitudinal profile of FXI and FXII antigenic levels and function before, during, and after ECMO in children. Methods: This is a prospective observational study in neonatal and pediatric patients with ECMO (<18 years). All patients with venoarterial ECMO and with sufficient plasma volume collected before ECMO, on day 1 and day 3, and 24 hours postdecannulation were included. Antigenic levels and functional activity of FXI and FXII were determined in these samples. Longitudinal profiles of these values were created using a linear mixed model. Results: Sixteen patients were included in this study. Mean FXI and FXII antigenic levels (U/mL) changed from 7.9 and 53.2 before ECMO to 6.0 and 34.5 on day 3 and they recovered to 8.8 and 39.4, respectively, after stopping ECMO. Function (%) of FXI and FXII decreased from 59.1 and 59.0 to 49.0 and 50.7 on day 3 and recovered to 66.0 and 54.4, respectively. Conclusion: This study provides the first insights into changes of the contact pathway in children undergoing ECMO. FXI and FXII antigen and function change during ECMO. Results from this study can be used as starting point for future contact pathway anticoagulant studies in pediatric patients with ECMO.

Published
2023

12. Changes in von Willebrand Factor Multimers, Concentration, and Function During Pediatric Extracorporeal Membrane Oxygenation*

Author

Van Den Helm, Suelyn, primary, Letunica, Natasha, additional, Barton, Rebecca, additional, Weaver, Asami, additional, Yaw, Hui Ping, additional, Karlaftis, Vasiliki, additional, McCafferty, Conor, additional, Cai, Tengyi, additional, Newall, Fiona, additional, Horton, Stephen B., additional, Chiletti, Roberto, additional, Johansen, Amy, additional, Best, Derek, additional, McKittrick, Joanne, additional, Butt, Warwick, additional, d’Udekem, Yves, additional, MacLaren, Graeme, additional, Linden, Matthew D., additional, Ignjatovic, Vera, additional, and Monagle, Paul, additional

Published
2023
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19. Carboxyhemoglobin levels in children during extracorporeal membrane oxygenation support: a retrospective study.

Author

Kimura, Satoshi, Gelbart, Ben, Chiletti, Roberto, Stephens, David, and Butt, Warwick

Subjects
CARDIOPULMONARY resuscitation, CONFIDENCE intervals, HEMOLYSIS & hemolysins, EXTRACORPOREAL membrane oxygenation, RETROSPECTIVE studies, MANN Whitney U Test, FISHER exact test, DESCRIPTIVE statistics, CHI-squared test, CARBOXYHEMOGLOBIN, DISEASE risk factors, CHILDREN
Abstract

Introduction: Hemolysis is a common complication of extracorporeal membrane oxygenation (ECMO). There are few data on whether carboxyhemoglobin (COHb), a potential marker of hemolysis, are elevated during ECMO support. Methods: We conducted a single-center, retrospective study comparing peak COHb levels of children pre-, during, and post-ECMO from January 2017 to August 2020. Results: There were 154 ECMO runs in 147 children (154 PICU admissions) included in the study. The median age was 3.5 (IQR 0.2, 39.2) months. Veno-arterial ECMO was the predominant mode: 146/154 (94.8%). Eighty-seven children (56.5%) underwent cardiac surgery. Peak COHb levels during ECMO were statistically significantly higher compared to pre ECMO (COHb 1.8% (IQR 1.4, 2.6) vs COHb 1.2% (IQR 0.7, 1.7), p < 0.001) and post ECMO (COHb 1.6% (IQR 1.3, 2.2), p = 0.009). Children with COHb ⩾2% were younger and had longer duration of ECMO support. Plasma hemoglobin weakly correlated with COHb level (r = 0.14; p = 0.04). Conclusions: Carboxyhemoglobin levels increased during ECMO support compared to the pre and post ECMO period. Younger age and longer ECMO duration were associated with COHb levels ⩾2%. Plasma hemoglobin weakly correlated with COHb level. [ABSTRACT FROM AUTHOR]

Published
2022
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21. sj-pdf-1-prf-10.1177_02676591211027776 – Supplemental material for Carboxyhemoglobin levels in children during extracorporeal membrane oxygenation support: a retrospective study

Author

Kimura, Satoshi, Gelbart, Ben, Chiletti, Roberto, Stephens, David, and Butt, Warwick

Subjects
FOS: Clinical medicine, Cardiology, 110323 Surgery
Abstract

Supplemental material, sj-pdf-1-prf-10.1177_02676591211027776 for Carboxyhemoglobin levels in children during extracorporeal membrane oxygenation support: a retrospective study by Satoshi Kimura, Ben Gelbart, Roberto Chiletti, David Stephens and Warwick Butt in Perfusion

Published
2021
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25. MOESM7 of Defining benefit threshold for extracorporeal membrane oxygenation in children with sepsisâ€'a binational multicenter cohort study

Author

Luregn Schlapbach, Chiletti, Roberto, Lahn Straney, Festa, Marino, Alexander, Daniel, Butt, Warwick, and MacLaren, Graeme

Subjects
surgical procedures, operative
Abstract

Additional file 7. Extracorporeal Membrane Oxygenation (ECMO) flow rates measured at 4 hours (in ml/kg/min) post cannulation in n=80 children treated with veno-arterial ECMO for septic shock. Flow rates are compared between children that underwent peripheral cannulation (n=23) versus children that underwent central cannulation (n=57), split into those that survived (n=44) and that died (n=36).

Published
2019
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26. Defining benefit threshold for extracorporeal membrane oxygenation in children with sepsis : A binational multicenter cohort study

Author

Schlapbach, Luregn, Chiletti, Roberto, Straney, Lahn, Festa, Marino, Alexander, Daniel, Butt, Warwick, MacLaren, Graeme, Ganeshalingam, Anusha, Sherring, Claire, Erickson, Simon, Barr, Samantha, Schibler, Andreas, Long, Debbie, Alexander, Jan, George, Shane, Williams, Gary, Smith, Vicky, Delzoppo, Carmel, Millar, Johnny, Gelbart, Ben, Oberender, Felix, Ganu, Subodh, Letton, Georgia, Egan, Jonathan, Harper, Gail, Schlapbach, Luregn, Chiletti, Roberto, Straney, Lahn, Festa, Marino, Alexander, Daniel, Butt, Warwick, MacLaren, Graeme, Ganeshalingam, Anusha, Sherring, Claire, Erickson, Simon, Barr, Samantha, Schibler, Andreas, Long, Debbie, Alexander, Jan, George, Shane, Williams, Gary, Smith, Vicky, Delzoppo, Carmel, Millar, Johnny, Gelbart, Ben, Oberender, Felix, Ganu, Subodh, Letton, Georgia, Egan, Jonathan, and Harper, Gail

Abstract

Background: The surviving sepsis campaign recommends consideration for extracorporeal membrane oxygenation (ECMO) in refractory septic shock. We aimed to define the benefit threshold of ECMO in pediatric septic shock. Methods: Retrospective binational multicenter cohort study of all ICUs contributing to the Australian and New Zealand Paediatric Intensive Care Registry. We included patients < 16 years admitted to ICU with sepsis and septic shock between 2002 and 2016. Sepsis-specific risk-adjusted models to establish ECMO benefit thresholds with mortality as the primary outcome were performed. Models were based on clinical variables available early after admission to ICU. Multivariate analyses were performed to identify predictors of survival in children treated with ECMO. Results: Five thousand sixty-two children with sepsis and septic shock met eligibility criteria, of which 80 (1.6%) were treated with veno-arterial ECMO. A model based on 12 clinical variables predicted mortality with an AUROC of 0.879 (95% CI 0.864-0.895). The benefit threshold was calculated as 47.1% predicted risk of mortality. The observed mortality for children treated with ECMO below the threshold was 41.8% (23 deaths), compared to a predicted mortality of 30.0% as per the baseline model (16.5 deaths; standardized mortality rate 1.40, 95% CI 0.89-2.09). Among patients above the benefit threshold, the observed mortality was 52.0% (13 deaths) compared to 68.2% as per the baseline model (16.5 deaths; standardized mortality rate 0.61, 95% CI 0.39-0.92). Multivariable analyses identified lower lactate, the absence of cardiac arrest prior to ECMO, and the central cannulation (OR 0.31, 95% CI 0.10-0.98, p = 0.046) as significant predictors of survival for those treated with VA-ECMO. Conclusions: This binational study demonstrates that a rapidly available sepsis mortality prediction model can define thresholds for survival benefit in children with septic shock considered for ECMO. Survival on ECMO

Published
2019

31. Role of levosimendan in weaning children requiring veno-arterial extracorporeal membrane oxygenation after cardiac surgery.

Author

Pan, Kevin C, Shankar, Sai, Millar, Johnny, Chiletti, Roberto, Butt, Warwick, d'Udekem, Yves, and Namachivayam, Siva P

Subjects
EXTRACORPOREAL membrane oxygenation, CARDIAC surgery, LEVOSIMENDAN, CARDIOPULMONARY bypass, HOSPITAL mortality
Abstract

OBJECTIVES Open in new tab Download slide Open in new tab Download slide Levosimendan use is associated with more successful decannulation from veno-arterial extracorporeal membrane oxygenation (VA ECMO) in adults. We sought to determine the role of levosimendan in children who required VA ECMO after cardiac surgery. METHODS This observational study compares the outcomes of children who required VA ECMO after cardiac surgery and received levosimendan for weaning with those who did not receive the drug. A doubly robust estimation methodology (inverse probability of treatment weighting with regression adjustment) was used to balance study covariates (age, weight, sex, lactate pre-ECMO, vasoactive-inotropic score pre-ECMO, ECMO indication, ECMO modality, Risk Adjustment for Congenital Heart Surgery-1 category), and the final model was further adjusted for duration of ECMO. RESULTS Between January 2012 and December 2018, 118 eligible children received 145 ECMO runs [failed weaning from cardiopulmonary bypass, 67/145 (46%); low cardiac output state, 30/145 (21%); extracorporeal cardiopulmonary resuscitation, 47/145 (32%); other reasons in 1]. Levosimendan was administered before decannulation in 54/145 (37%) runs. The median time to start levosimendan after ECMO cannulation was 39 h (interquartile range, 14–83 h). The unadjusted rates of weaning failure in the levosimendan vs control group were 7% (4/54) vs 19% (17/91). In the controlled analysis, levosimendan was associated with decreased risk of weaning failure [adjusted relative risk (95% confidence interval), 0.20 (0.07–0.57)] and decreased risk of in-hospital mortality [adjusted relative risk (95% confidence interval), 0.45 (0.26–0.76)]. CONCLUSIONS Levosimendan administration in children requiring VA ECMO after cardiac surgery was associated with decreased risk of weaning failure and decreased in-hospital mortality. [ABSTRACT FROM AUTHOR]

Published
2021
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32. Defining benefit threshold for extracorporeal membrane oxygenation in children with sepsis-a binational multicenter cohort study.

Author

Schlapbach, Luregn J., Chiletti, Roberto, Straney, Lahn, Festa, Marino, Alexander, Daniel, Butt, Warwick, MacLaren, Graeme, on behalf of the Australian New Zealand Intensive Care Society (ANZICS) Centre for Outcomes Resource Evaluation (CORE) and the Australian New Zealand Intensive Care Society (ANZICS) Paediatric Study Group, Ganeshalingam, Anusha, Sherring, Claire, Erickson, Simon, Barr, Samantha, Schibler, Andreas, Long, Debbie, Schlapbach, Luregn, Alexander, Jan, George, Shane, Williams, Gary, Smith, Vicky, and Delzoppo, Carmel

Abstract

Background: The surviving sepsis campaign recommends consideration for extracorporeal membrane oxygenation (ECMO) in refractory septic shock. We aimed to define the benefit threshold of ECMO in pediatric septic shock.Methods: Retrospective binational multicenter cohort study of all ICUs contributing to the Australian and New Zealand Paediatric Intensive Care Registry. We included patients < 16 years admitted to ICU with sepsis and septic shock between 2002 and 2016. Sepsis-specific risk-adjusted models to establish ECMO benefit thresholds with mortality as the primary outcome were performed. Models were based on clinical variables available early after admission to ICU. Multivariate analyses were performed to identify predictors of survival in children treated with ECMO.Results: Five thousand sixty-two children with sepsis and septic shock met eligibility criteria, of which 80 (1.6%) were treated with veno-arterial ECMO. A model based on 12 clinical variables predicted mortality with an AUROC of 0.879 (95% CI 0.864-0.895). The benefit threshold was calculated as 47.1% predicted risk of mortality. The observed mortality for children treated with ECMO below the threshold was 41.8% (23 deaths), compared to a predicted mortality of 30.0% as per the baseline model (16.5 deaths; standardized mortality rate 1.40, 95% CI 0.89-2.09). Among patients above the benefit threshold, the observed mortality was 52.0% (13 deaths) compared to 68.2% as per the baseline model (16.5 deaths; standardized mortality rate 0.61, 95% CI 0.39-0.92). Multivariable analyses identified lower lactate, the absence of cardiac arrest prior to ECMO, and the central cannulation (OR 0.31, 95% CI 0.10-0.98, p = 0.046) as significant predictors of survival for those treated with VA-ECMO.Conclusions: This binational study demonstrates that a rapidly available sepsis mortality prediction model can define thresholds for survival benefit in children with septic shock considered for ECMO. Survival on ECMO was associated with central cannulation. Our findings suggest that a fully powered RCT on ECMO in sepsis is unlikely to be feasible. [ABSTRACT FROM AUTHOR]

Published
2019
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36. Provision of continuous renal replacement therapy in children in intensive care in Australia and New Zealand

Author

Killick, Caroline J., Oberender, Felix, Ganu, Subodh, Gibbons, Kristen, Agarwal, Sidharth, Chiletti, Roberto, Erickson, Simon, Jackson, Hamish, Numa, Andrew, Plumpton, Kevin, Wiseman, Greg, Nakazawa, Kiraka, Ganu, Subodh, and Hunter, John

Abstract

The objective of this study was to describe current use, clinical practice, and outcomes of continuous renal replacement therapy (CRRT) in children in the intensive care unit (ICU) in Australia and New Zealand.

Published
2024
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37. Extracorporeal membrane oxygenation for neonatal collapse caused by enterovirus myocarditis.

Author

Cortina, Gerard, Best, Derek, Deisenberg, Markus, Chiletti, Roberto, and Butt, Warwick

Subjects
EXTRACORPOREAL membrane oxygenation, MYOCARDITIS, ENTEROVIRUSES, MENINGOENCEPHALITIS, CARDIAC arrest, INTENSIVE care units
Abstract

Objective: To describe the effect of extracorporeal membrane oxygenation (ECMO) on survival and cardiac outcome of neonates with myocardial failure secondary to severe enterovirus (EV) myocarditis.Design: Retrospective case series.Setting: A 15-bed cardiac paediatric intensive care unit (ICU).Patients: We describe the clinical presentations, cardiac findings, ECMO characteristics and outcome of seven neonates with severe EV myocarditis. Additionally, 35 previously reported cases of EV myocarditis supported with ECMO are presented.Interventions: Extracorporeal membrane oxygenation.Results: Seven neonates presented with cardiovascular collapse within the first 10 days after birth and required ECMO support. Echocardiography showed left ventricular dysfunction in all and additional right ventricular dysfunction in four patients. ECG showing widespread ST changes as well as elevated troponin I indicated myocardial damage. All patients were cannulated onto ECMO shortly after ICU admission. None of the patients suffered cardiac arrest prior to ECMO initiation. Four patients survived ECMO and three survived to hospital discharge. All three survivors showed complete cardiac recovery after a median follow-up of 34 months. The survival rate in 35 previously reported cases was 34% (12/35) and including our seven cases 36% (15/42).Conclusions: In this case series, ECMO initiation prevented further deterioration and cardiac arrest in neonates with severe EV myocarditis and not responding to conventional medical therapies. Moreover, complete cardiac recovery occurred in survivors. However, these neonates may need long ECMO runs and are at increased risk for mechanical complications. Furthermore, mortality remains high due to greater disease severity. [ABSTRACT FROM AUTHOR]

Published
2018
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39. Abstract 13815: Effect of S-Nitrosoglutathione on Cardiovascular Dysfunction in a Paediatric Animal Model of Cardiopulmonary Bypass

Author

Chiletti, Roberto, Kenna, Kelly, Smolich, Joe, Bennett, Martin, Stephanie, Perrier, Brink, Johann, Zannino, Diana, Angerosa, Julie, Pepe, Salvatore, and Cheung, Michael

Abstract

Introduction:Myocardial dysfunction remains a major contributor of morbidity and mortality in children after cardiopulmonary bypass (CPB). During hypoxia or acidosis, S-nitrosoglutathione (GSNO) has been shown to protect the cardiomyocyte from ischemia-reperfusion injury through protein transnitrosylation, glutathionylation, and nitric oxide release resulting in maintenance of intracellular calcium homeostasis. The objective of this study was to determine the possible beneficial effect of different doses of GSNO infusion on cardiovascular dysfunction in an animal model of CPB.Methods:20 pigs (mean weight 18 kg) were exposed to CPB with one hour of aortic cross-clamp. Pre- and during CPB, animals were randomised to receive low dose (up to 20 nmol/kg/min) GSNO (n=8), high dose (up to 60 nmol/kg/min) GSNO (n=6) or normal saline (n=6) infusions. The dose of GSNO was titrated up to the target dose as tolerated by reductions in systemic blood pressure less than 20% from baseline. Standard cardiac intensive care management was continued for 4 hours post-bypass. Group differences for indices of function were assessed.Results:At 4 hours post-CPB, there was a trend towards less reduction in cardiac output for the low dose GSNO group however the difference was not significant. Increases in pulmonary vascular resistance (PVR) were ameliorated by low dose GSNO in comparison to high dose GSNO and controls (p=0.007). There was less systolic and diastolic dysfunction with low dose GSNO in comparison to high dose GSNO and controls. There was no difference in inotrope requirement post-CPB.Conclusions:GSNO administered at low dose (up to 20 nmol/kg/min) immediately prior to and during CPB was associated with improved left ventricular contractility and relaxation as well as reduced pulmonary vascular resistance at four hours post-CPB compared to controls. These beneficial effects were not observed with high dose GSNO.

Published
2019
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42. Comprehensive Characterization of Surface-Bound Proteins and Measurement of Fibrin Fiber Thickness on Extracorporeal Membrane Oxygenation Circuits Collected From Patients.

Author

Cai T, Emery-Corbin SJ, McCafferty C, Van Den Helm S, Letunica N, Attard C, Barton R, Horton S, Bottrell S, Schultz B, MacLaren G, Chiletti R, Best D, Johansen A, Newall F, Butt W, d'Udekem Y, Dagley LF, Yousef JM, Monagle P, and Ignjatovic V

Abstract

Objective: To characterize surface-bound proteins and to measure the thickness of fibrin fibers bound to extracorporeal membrane oxygenation (ECMO) circuits used in children., Design: Single-center observational prospective study, April to November 2021., Setting: PICU, Royal Children's Hospital, Melbourne, Australia., Patients: Patients aged less than 18 years on venoarterial ECMO and without preexisting disorder., Interventions: None., Measurements and Main Results: ECMO circuits were collected from six patients. Circuit samples were collected from five different sites, and subsequently processed for proteomic and scanning electron microscopy (SEM) studies. The concentration of proteins bound to ECMO circuit samples was measured using a bicinchoninic acid protein assay, whereas characterization of the bound proteome was performed using data-independent acquisition mass spectrometry. The Reactome Over-representation Pathway Analyses tool was used to identify functional pathways related to bound proteins. For the SEM studies, ECMO circuit samples were prepared and imaged, and the thickness of bound fibrin fibers was measured using the Fiji ImageJ software, version 1.53c (https://imagej.net/software/fiji/). Protein binding to ECMO circuit samples and fibrin networks showed significant intra-circuit and interpatient variation. The median (range) total protein concentration was 19.0 (0-76.9) μg/mL, and the median total number of proteins was 2011 (1435-2777). A total of 933 proteins were commonly bound to ECMO circuit samples from all patients and were functionally involved in 212 pathways, with signal transduction, cell cycle, and metabolism of proteins being the top three pathway categories. The median intra-circuit fibrin fiber thickness was 0.20 (0.15-0.24) μm, whereas the median interpatient fibrin fiber thickness was 0.18 (0.15-0.21) μm., Conclusions: In this report, we have characterized proteins and fiber fibrin thickness bound to ECMO circuits in six children. The techniques and approaches may be useful for investigating interactions between blood, coagulation, and the ECMO circuit and have the potential for circuit design., Competing Interests: Drs. McCafferty and Monagle’s institution received funding from the National Health and Medical Research Council (NHMRC) grant APP1129317. Dr. Attard’s institution received funding from the National Blood Authority, Bayer, and Janssen; he received funding from Anthos; he received support for article research from the NHMRC. Dr. MacLaren reported that he serves on the board of directors of the Extracorporeal Life Support Organization (unpaid). The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Published
2024
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43. Characterization of Protein Binding on an Extracorporeal Membrane Oxygenation (ECMO) Circuit Following the Priming Procedure.

Author

Cai T, Emery-Corbin SJ, McCafferty C, Van Den Helm S, Letunica N, Barton R, Attard C, Horton S, Bottrell S, Schultz B, MacLaren G, Chiletti R, Best D, Johansen A, Newall F, Butt W, d'Udekem Y, Dagley LF, Yousef JM, Monagle P, and Ignjatovic V

Abstract

Competing Interests: Disclosure: G.M. is the President of the Extracorporeal Life Support Organization (ELSO) (unpaid). The other authors have no conflicts of interest to report. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending royalties.

Published
2024
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44. Immunofluorescence Protocol for Characterization of Platelet and Leukocyte Binding in Extracorporeal Membrane Oxygenation (ECMO) Circuits.

Author

Cai T, Burton M, McCafferty C, Van Den Helm S, Letunica N, Attard C, Horton S, Bottrell S, Schultz B, MacLaren G, Chiletti R, Best D, Johansen A, Newall F, Butt W, d'Udekem Y, Monagle P, and Ignjatovic V

Abstract

The continuous contact between blood and the foreign surface of the extracorporeal membrane oxygenation (ECMO) circuit contributes to hemostatic, inflammatory, and other physiological disturbances observed during ECMO. Although previous studies have extensively investigated blood samples from patients on ECMO, cell adsorption to the ECMO circuit as an additional factor that could potentially influence clinical outcomes, has largely been overlooked. Here we provide a detailed immunofluorescence (IF) protocol designed to characterize cellular binding on ECMO circuits collected from patients. Extracorporeal membrane oxygenation circuits were collected from three pediatric patients and an albumin primed-only ECMO circuit was used as control. Circuit samples from five different sites within each ECMO circuit were collected and processed for the IF protocol. CD14 and CD42a antibodies were used to identify platelets and leukocytes bound to each ECMO circuit sample and images captured using inverted fluorescence microscopy. The protocol enables the comprehensive characterization of platelet and leukocyte binding to ECMO circuits collected from patients, which could in turn extend our knowledge of the characteristics of circuit binding and may provide guidance for improved ECMO circuit design., Competing Interests: G.M. is the president of the Extracorporeal Life Support Organization (ELSO). The other authors have no conflicts of interest to report., (Copyright © ASAIO 2024.)

Published
2024
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45. Top 10 research priorities for congenital diaphragmatic hernia in Australia: James Lind Alliance Priority Setting Partnership.

Author

Chiletti R, Vodopic C, Hunt E, Lawer J, Bertinetti M, Malarbi S, Kyritsis V, Petersen S, Stewart D, Hellstern J, Stewart M, Hickey L, Tingay DG, and Prentice TM

Abstract

Objectives: The Gaps in the Congenital Diaphragmatic Hernia (CDH) Journey Priority Setting Partnership (PSP) was developed in collaboration with CDH Australia, James Lind Alliance (JLA) and the Murdoch Children's Research Institute to identify research priorities for people with CDH, their families and healthcare workers in Australasia., Design: Research PSP in accordance with the JLA standardised methodology., Setting: Australian community and institutions caring for patients with CDH and their families., Patients: CDH survivors, families of children born with CDH (including bereaved) and healthcare professionals including critical care physicians and nurses (neonatal and paediatric), obstetric, surgical, allied health professionals (physiotherapists, speech pathologists and speech therapists) and general practitioners., Main Outcome Measure: Top 10 research priorities for CDH., Results: 377 questions, from a community-based online survey, were categorised and collated into 50 research questions. Through a further prioritisation process, 21 questions were then discussed at a prioritisation workshop where they were ranked by 21 participants (CDH survivors, parents of children born with CDH (bereaved and not) and 11 multidisciplinary healthcare professionals) into their top 10 research priorities., Conclusion: Stakeholders' involvement identified the top 10 CDH-related research questions, spanning from antenatal care to long-term functional outcomes, that should be prioritised for future research to maximise meaningful outcomes for people with CDH and their families., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Published
2024
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