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Extracorporeal Membrane Oxygenation in Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute
Jérome Rambaud1, Ryan P Barbaro2, Duncan J Macrae3
1Departement of Pediatric and Neonatal Intensive Care, Armand-Trousseau Hospital, Sorbonne University, Paris, France.
Insights
This review provides updated clinical practice and research recommendations for extracorporeal membrane oxygenation (ECMO) in pediatric acute respiratory distress syndrome (PARDS). It synthesizes evidence to guide ECMO use in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Extracorporeal Life Support
Background:
- Pediatric acute respiratory distress syndrome (PARDS) is a severe condition requiring advanced respiratory support.
- Extracorporeal membrane oxygenation (ECMO) is a vital therapy for severe PARDS, but clinical practice guidelines require regular updates.
- The Pediatric Acute Lung Injury Consensus Conference (PALICC) aims to refine recommendations for ECMO in PARDS.
Approach:
- A systematic literature review was conducted using MEDLINE, Embase, and CINAHL Complete databases.
- Studies focused on ECMO for PARDS or acute respiratory failure, excluding animal models and case reports.
- The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach informed evidence synthesis and recommendation development.
Key Points:
- Eighteen studies were included in the full-text review, with consideration of adult and neonatal data when pediatric data was limited.
- Six clinical recommendations were generated covering ECMO indications, initiation, and management in PARDS.
- Three good practice statements, two policy statements (on team organization and training), and one research statement were developed.
Conclusions:
- The review proposes updated clinical management, good practice, and policy statements for ECMO in PARDS.
- These statements address critical aspects including indications, initiation, team organization, training, management, and follow-up.
- The findings aim to enhance the quality of care and guide future research in pediatric ECMO for respiratory failure.
Objectives:
To systematically review and assimilate literature on children receiving extracorporeal membrane oxygenation (ECMO) support in pediatric acute respiratory distress syndrome (PARDS) with the goal of developing an update to the Pediatric Acute Lung Injury Consensus Conference recommendations and statements about clinical practice and research.
Data Sources:
Electronic searches of MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
Study Selection:
The search used a medical subject heading terms and text words to capture studies of ECMO in PARDS or acute respiratory failure. Studies using animal models and case reports were excluded from our review.
Data Extraction:
Title/abstract review, full-text review, and data extraction using a standardized data collection form.
Data Synthesis:
The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. There were 18 studies identified for full-text extraction. When pediatric data was lacking, adult and neonatal data from randomized clinical trials and observational studies were considered. Six clinical recommendations were generated related to ECMO indications, initiation, and management in PARDS. There were three good practice statements generated related to ECMO indications, initiation, and follow-up in PARDS. Two policy statements were generated involving the impact of ECMO team organization and training in PARDS. Last, there was one research statement.
Conclusions:
Based on a systematic literature review, we propose clinical management, good practice and policy statements within the domains of ECMO indications, initiation, team organization, team training, management, and follow-up as they relate to PARDS.
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