Decompressive laparotomy for abdominal compartment syndrome in children on ECMO: effect on support and survival

Area of Science:

• Pediatric critical care medicine
• Surgical critical care

Background:

• Abdominal compartment syndrome (ACS) is a serious complication of Extracorporeal Membrane Oxygenation (ECMO).
• ACS can compromise ECMO function by increasing intra-abdominal pressure, leading to inadequate venous return and patient support.
• The role of decompressive laparotomy in ECMO patients with ACS is debated due to potential risks and poor prognosis.

Purpose of the Study:

• To evaluate the impact of decompressive laparotomy on ECMO support and patient survival in children with ACS.
• To assess the physiological changes and ECMO circuit performance following decompressive laparotomy in this patient population.

Main Methods:

• Retrospective review of a tertiary care children's hospital ECMO registry (2000-2011).
• Identification of patients who underwent decompressive laparotomy for ACS, defined by abdominal hypertension and hemodynamic instability.
• Comparison of physiological parameters and ECMO venous return before and after laparotomy using a signed rank test.

Main Results:

• Seven patients with ACS complicating ECMO were identified.
• Decompressive laparotomy led to significant improvements in physiological parameters and ECMO venous return.
• No survivors were recorded, but three patients were stabilized for organ donation.

Conclusions:

• Decompressive laparotomy significantly improves ECMO support and tissue perfusion in patients with ACS.
• Despite a poor prognosis in this series, the limited sample size prevents definitive conclusions on the futility of this intervention.
• Further research is needed to clarify the role of decompressive laparotomy in managing ECMO patients with ACS.