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Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
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ECLS in Pediatric Cardiac Patients.

Matteo Di Nardo1, Graeme MacLaren2, Marco Marano1

  • 1Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù , Rome , Italy.

Frontiers in Pediatrics
|October 25, 2016
PubMed
Summary
This summary is machine-generated.

Extracorporeal life support (ECLS) offers critical care for children with severe heart or lung failure. Extracorporeal membrane oxygenation (ECMO) is a key ECLS method, with expanding uses like extracorporeal cardiopulmonary resuscitation (ECPR) showing promising survival rates.

Keywords:
ECMOVADchildrenheart failureneonates

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Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Cardiopulmonary Support

Background:

  • Extracorporeal life support (ECLS) is vital for pediatric patients with severe refractory cardiac or pulmonary failure.
  • Available ECLS methods include extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs), each with distinct pros and cons.
  • Intra-aortic balloon pumps are effective in older patients but less so in smaller children.

Approach:

  • This review details the current state of ECMO in neonates and children experiencing heart failure.
  • It emphasizes the critical importance of patient selection and timely intervention to optimize outcomes.
  • The review advocates for initiating ECLS urgently, before end-organ dysfunction or circulatory collapse, to improve survival.

Key Points:

  • ECMO is a primary mechanical circulatory support for children with complex cardiac anatomy, especially those requiring rapid resuscitation or with univentricular circulation.
  • New indications for ECMO, such as extracorporeal cardiopulmonary resuscitation (ECPR), are emerging, with growing evidence supporting its use in pediatric in-hospital cardiac arrest.
  • Contraindications for ECLS have lessened, enabling support for more complex cases, including those with univentricular circulations, leading to improved outcomes.

Conclusions:

  • ECMO remains the cornerstone of mechanical circulatory support for critically ill children with cardiac conditions.
  • The expansion of ECLS indications, including ECPR, and improved patient management strategies are enhancing survival rates in pediatric critical care.
  • Continued advancements in VAD technology and broader application of ECLS are crucial for managing pediatric heart failure.