Pushing the Envelope: 'Awake Venoarterial Extracorporeal Membrane Oxygenation' in Pediatric Patients with Acute Cardiac Failure

Objectives: In pediatric patients with cardiogenic shock (CS)/or acute cardiac failure (ACF) extracorporeal membrane oxygenation (ECMO) is often used as a bridging procedure to recovery or further implantation of a ventricular assist device (VAD). Although ECMO has been established as a routine procedure in pediatric tertiary care centers, the clinical path guiding these patients to fully recovery or further VAD implantation is one of the most challenging for pediatric intensivists. Methods: The authors describe the use of venoarterial ECMO (VA-ECMO) as a treatment strategy for ACF in spontaneously breathing and conscious pediatric patients. It presents their experiences with the first five children treated using this new concept. The mean age of the patients was 86 months (range 0 – 226 mo). Mean amount of time on ECMO was 35 days (range 7 – 94 d). Results: Three patients fully recovered with their cardiac function while being treated on “Awake-VA-ECMO,” one was bridged to LVAD and one was successfully bridged to transplantation. Four of the five patients are alive without any recurrences. One patient died before a further heart transplantation while being on intracardiac rotation pump. Although reintubation was necessary in three of our five patients (due to interventional heart catheter) total time breathing spontaneously and being conscious while on ECMO was > 70%. Conclusion: The authors conclude that the concept of “Awake VA-ECMO” is feasible and safe for the treatment of ACF and can be used as a “bridging therapy” to recovery or further VAD implantation in pediatric patients.