Systemic Hypertension in Pediatric Veno-Venous Extracorporeal Membrane Oxygenation

Area of Science:

• Pediatric critical care medicine
• Cardiovascular research
• Nephrology

Background:

• Systemic hypertension (HTN) is a known complication of veno-venous extracorporeal membrane oxygenation (VV ECMO) in pediatric patients.
• Understanding the prevalence and contributing factors of HTN during VV ECMO is crucial for patient management.

Purpose of the Study:

• To determine the prevalence of HTN in children (>1 year old) supported with VV ECMO.
• To identify associated patient and ECMO-related factors contributing to HTN in this cohort.

Main Methods:

• Retrospective cohort study of 23 children (>1 year old) receiving VV ECMO from January 2015 to July 2019.
• Analysis of patient demographics, ECMO duration, ICU length of stay, medication exposure (corticosteroids, nephrotoxins), acute kidney injury (AKI), fluid balance, and transfusion data.
• Diagnosis of HTN based on established criteria during ECMO support.

Main Results:

• HTN was diagnosed in 87% of children, typically within 25 ECMO hours.
• Hypertension persisted for over 50% of the ECMO duration in 55% of affected patients.
• Acute kidney injury and fluid overload were present in over 50% of the cohort; nearly all patients received nephrotoxic medications and corticosteroids.

Conclusions:

• Systemic hypertension is highly prevalent in children requiring VV ECMO, often appearing early in treatment.
• The multifactorial etiology likely involves factors such as AKI, fluid overload, and medication exposure.
• Further research is needed to elucidate specific mechanisms and optimize management strategies for HTN during pediatric VV ECMO.