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Pediatric Extracorporeal Cardiopulmonary Resuscitation (ECPR): Understanding Variations in Systems and Clinical Practice.

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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
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Pediatric Extracorporeal Membrane Oxygenation.

Christopher Loren Jenks1, Lakshmi Raman2, Heidi J Dalton3

  • 1Department of Pediatrics, Section Critical Care Medicine, Cardiac Intensive Care Unit, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA.

Critical Care Clinics
|September 10, 2017
PubMed
Summary

Extracorporeal membrane oxygenation (ECMO) is a modified cardiopulmonary bypass. Survival rates for pediatric cardiac and respiratory ECMO support remain around 50% to 60%.

Keywords:
Centrifugal technologyFluid overloadNutritionPediatric extracorporeal life supportPediatric extracorporeal membrane oxygenation

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Area of Science:

  • Cardiovascular and Respiratory Support Technologies
  • Pediatric Critical Care Medicine

Background:

  • Extracorporeal life support (ECL) is an advanced form of cardiopulmonary bypass.
  • Extracorporeal membrane oxygenation (ECMO) experience predominantly originates from neonatal applications.
  • Centrifugal pumps have largely replaced roller pumps in ECMO technology.

Purpose of the Study:

  • To review current practices and outcomes in pediatric extracorporeal membrane oxygenation.
  • To highlight advancements in ECMO technology and patient management.
  • To discuss survival rates and common complications associated with pediatric ECMO.

Main Methods:

  • Review of established extracorporeal membrane oxygenation (ECMO) techniques.
  • Description of venovenous (respiratory) and venoarterial (cardiac) ECMO modes.
  • Discussion of emerging trends like "awake" ECMO and management strategies.

Main Results:

  • Fluid overload is a frequent complication, managed with diuretics or hemofiltration.
  • Nutritional support is crucial, delivered enterally or via total parenteral nutrition.
  • Pediatric cardiac and respiratory ECMO survival rates are approximately 50% to 60%.

Conclusions:

  • Extracorporeal membrane oxygenation (ECMO) is a vital support system in pediatric critical care.
  • Advances in technology and management are ongoing, but survival rates require further improvement.
  • Effective management of complications like fluid overload and provision of nutrition are key to optimizing outcomes.