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'Awake Veno-arterial Extracorporeal Membrane Oxygenation' in Pediatric Cardiogenic Shock: A Single-Center Experience
- Source :
- Pediatric Cardiology. 36:1647-1656
- Publication Year :
- 2015
- Publisher :
- Springer Science and Business Media LLC, 2015.
-
Abstract
- In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients. We therefore present data of six of our patients with CS, who were treated by ECMO being awake without continuous analgosedation and invasive ventilation. Of these six patients, four were1 year and two14 years of age. Median time on ECMO was 17.4 days (range 6.9-94.2 days). Median time extubated, while receiving ECMO support was 9.5 days. Mean time extubated was 78 % of the total time on ECMO. Three patients reached full recovery of cardiac function on "Awake-VA-ECMO," whereas the other three were successfully bridged to destination therapy (VAD, heart transplantation, withdrawal). Four out of our six patients are still alive. Complications related to ECMO therapy (i.e., severe bleeding, site infection or dislocation of cannulas) were not observed. We conclude that "Awake-VA-ECMO" in extubated, spontaneously breathing conscious pediatric patients is feasible and safe for the treatment of acute CS and can be used as a "bridging therapy" to recovery, VAD implantation or transplantation.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Shock, Cardiogenic
Single Center
Young Adult
Extracorporeal Membrane Oxygenation
Germany
medicine
Extracorporeal membrane oxygenation
Humans
Retrospective Studies
Heart transplantation
business.industry
Cardiogenic shock
Infant
Vascular surgery
medicine.disease
Cardiac surgery
Surgery
Transplantation
Treatment Outcome
surgical procedures, operative
Pediatrics, Perinatology and Child Health
Airway Extubation
Female
Cardiology and Cardiovascular Medicine
business
Destination therapy
Subjects
Details
- ISSN :
- 14321971 and 01720643
- Volume :
- 36
- Database :
- OpenAIRE
- Journal :
- Pediatric Cardiology
- Accession number :
- edsair.doi.dedup.....a2895421839329d999252a35d8cacdec