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ECMO for Pediatric Acute Respiratory Distress Syndrome (PARDS)

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Pediatric Acute Respiratory Distress Syndrome

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Abstract

Extracorporeal membrane oxygenation (ECMO) may be used for children with severe respiratory failure. ECMO removes blood from the venous circulation, instills oxygen and removes carbon dioxide, and then returns it to the patient. This may enable the clinician to substantially decrease mechanical ventilator settings from “toxic” ones to less injurious settings, which may facilitate recovery. General indications are intuitive, but specific indications for a given patient that improve outcomes have not been established. General treatment strategies, common adverse events, and long-term outcomes are also reviewed.

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References

  1. Valentine SL, Sapru A, Higgerson RA, Spinella PC, Flori HR, Graham DA, et al. Fluid balance in critically ill children with acute lung injury. Crit Care Med. 2012;40:2883–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. DeBruin W, Notterman DA, Magid M, Godwin T, Johnston S. Acute hypoxemic respiratory failure in infants and children: clinical and pathologic characteristics. Crit Care Med. 1992;20:1223–34.

    Article  CAS  PubMed  Google Scholar 

  3. Khemani RG, Smith L, Lopez-Fernandez YM, et al. Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE): an international observational study. Lancet Respir Med. 2019;7(2):115–28.

    Google Scholar 

  4. Aspesberro F, Mangione-Smith R, Zimmerman JJ. Health-related quality of life following pediatric critical illness. Intensive Care Med. 2015;41:1235–46.

    Article  PubMed  Google Scholar 

  5. Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016;374:62–72.

    Article  CAS  PubMed  Google Scholar 

  6. Barrett CS, Bratton SL, Salvin JW, et al. Neurological injury after extracorporeal membrane oxygenation use to aid pediatric cardiopulmonary resuscitation. Pediatr Crit Care Med. 2009;10:445–51.

    Article  PubMed  Google Scholar 

  7. Rollins MD, Hubbard A, Zabrocki L, et al. Extracorporeal membrane oxygenation cannulation trends for pediatric respiratory failure and central nervous system injury. J Pediatr Surg. 2012;47:68–75.

    Article  PubMed  Google Scholar 

  8. Gattinoni L, Protti A, Carlesso E, et al. Ventilator-induced lung injury: the anatomical and physiological framework. Crit Care Med. 2010;38:S539–48.

    Article  PubMed  Google Scholar 

  9. Kolobow T, Moretti MP, Fumagalli R, et al. Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation: an experimental study. Am Rev Respir Dis. 1987;135:312–5.

    CAS  PubMed  Google Scholar 

  10. Kumar A, Pontoppidan H, Falke KJ, et al. Pulmonary barotrauma during mechanical ventilation. Crit Care Med. 1973;1:181–6.

    Article  CAS  PubMed  Google Scholar 

  11. Dreyfuss D, Soler P, Basset G, et al. High inflation pressure pulmonary edema: respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis. 1988;137:1159–64.

    Article  CAS  PubMed  Google Scholar 

  12. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volume as compared with traditional tidal volume for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.

    Article  Google Scholar 

  13. Brogan TV, Lequier L, Lorusso R, MacLaren G, Peek G, editors. Extracorporeal life support: the ELSO Red Book. 5th ed. Ann Arbor: Extracorporeal Life Support Organization; 2017.

    Google Scholar 

  14. Hill JD, O’Brien TG, Murray JJ, et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock lung syndrome): use of the Bramson membrane lung. N Engl J Med. 1972;286:629–34.

    Article  CAS  PubMed  Google Scholar 

  15. Zapol WM, Snider MT, Hill JD, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective study. JAMA. 1979;242:2193–6.

    Article  CAS  PubMed  Google Scholar 

  16. Morris AH, Wallace CJ, Menlove RL, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;149:295–305.

    Article  CAS  PubMed  Google Scholar 

  17. Bartlett RH, Roloff DW, Cornell RG, et al. Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study. Pediatrics. 1985;76:479–87.

    CAS  PubMed  Google Scholar 

  18. O’Rourke PP, Crone RK, Vacanti JP, et al. Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: a prospective randomized study. Pediatrics. 1989;84:957–63.

    PubMed  Google Scholar 

  19. UK Collaborative ECMO Trial Group. UK collaborative randomized trial of neonatal extracorporeal membrane oxygenation. UK Collaborative ECMO Trail Group. Lancet. 1996;348:75–82.

    Article  Google Scholar 

  20. Green TP, Timmons OD, Fackler JC, et al. The impact of extracorporeal membrane oxygenation on survival in pediatric patients with acute respiratory failure. Pediatric Critical Care Study Group. Crit Care Med. 1996;24:323–9.

    Article  CAS  PubMed  Google Scholar 

  21. Barbaro RP, Xu Y, Borasino S, et al. Does extracorporeal membrane oxygenation improve survival in pediatric acute respiratory failure. Am J Respir Crit Care Med. 2018;197:1177–86.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–63.

    Article  PubMed  Google Scholar 

  23. Davies A, Jones D, Bailey M, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302:1888–95.

    Article  CAS  PubMed  Google Scholar 

  24. Noah MA, Peek GJ, Finney SJ, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011;306:1659–68.

    Article  CAS  PubMed  Google Scholar 

  25. Fackler J, Bohn D, Green T, et al. ECMO for ARDS: stopping a RCT. Abstr. Am J Respir Crit Care Med. 1997;155:A504.

    Google Scholar 

  26. Carpenter TC, Kinsella JP. Waiting for Godot: clinical trials of extracorporeal membrane oxygenation for pediatric respiratory failure (editorial). Am J Respir Crit Care Med. 2018;197:1103–4.

    Article  PubMed  Google Scholar 

  27. Berdajs D. Bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: Avalon cannula in childhood disease. Perfusion. 2015;30:182–6.

    Article  CAS  PubMed  Google Scholar 

  28. Jenks CL, Raman L, Dalton HJ. Pediatric extracorporeal membrane oxygenation. Crit Care Clin. 2017;33:825–41.

    Article  PubMed  Google Scholar 

  29. Gattinoni L, Kolobow T, Tomlinson T, Iapichino G, Samaja M, White D, Pierce J. Low-frequency positive pressure ventilation with extracorporeal carbon dioxide removal (LFPPVECCO2R): an experimental study. Anesth Analg. 1978;57:470–7.

    Article  CAS  PubMed  Google Scholar 

  30. Bein T, Weber-Carstens S, Goldmann A, et al. Lower tidal volume strategy (=3 ml/kg) combined with extracorporeal CO2 removal versus “conventional” protective ventilation (6 ml/kg) in severe ARDS. The prospective randomized Xtravent-study. Intensive Care Med. 2013;39:847–56.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lawson DS, Ing R, Cheifetz IM, et al. Hemolytic characteristics of three commercially available centrifugal blood pumps. Pediatr Crit Care Med. 2005;6:573–7.

    Article  PubMed  Google Scholar 

  32. Byrnes J, McKamie W, Swearingen C, et al. Hemolysis during cardiac extracorporeal membrane oxygenation: a case control comparison of roller pumps and centrifugal pumps in a pediatric population. ASAIO J. 2011;57:456–61.

    Article  PubMed  Google Scholar 

  33. https://www.google.com/search?client=safari&rls=en&q=maquet+quadrox+ecmo&ie=UTF-8&oe=UTF-8. Accessed 8 2018.

  34. Garcia AV, Jeyaraju M, Ladd MR, et al. Survey of the American Pediatric Surgical Association on cannulation practices in pediatric ECMO. J Pediatr Surg. 2018;53(9):1843–8.

    Article  PubMed  Google Scholar 

  35. Moscatelli A, Febbo F, Buratti S, Pezzato S, Bagnasco F, Lampugnani E, Nuri H, Buffelli F, Grasso C, Castagnola E. Intensivists performed percutaneous Bicaval double-lumen echo-guided extracorporeal membrane oxygenation cannulation at bedside in newborns and children: a retrospective analysis. Pediatr Crit Care Med. 2019;20(6):551–9.

    Article  PubMed  Google Scholar 

  36. Nishinaka T, Tatsumi E, Taenaka Y, Katagiri N, Ohnishi H, Shioya K, Fukuda T, Oshikawa M, Sato K, Tsukiya T, Homma A, Takewa Y, Takano H, Sato M, Kashiwabara S, Tanaka H, Sakai K, Matsuda T. At least thirty-four days of animal continuous perfusion by a newly developed extracorporeal membrane oxygenation system without systemic anticoagulants. Artif Organs. 2002;26:548–51.

    Article  CAS  PubMed  Google Scholar 

  37. Bailly DK, Reeder RW, Zabrocki LA, et al. Development and validation of a score to predict mortality in children undergoing ECMO for respiratory failure: pediatric pulmonary rescue with extracorporeal membrane oxygenation prediction (P-PREP) score. Crit Care Med. 2017;45:e58–66.

    Article  PubMed  Google Scholar 

  38. Barbaro RP, Boonstra PS, Paden ML, et al. Development and validation of the pediatric risk estimate score for children using extracorporeal respiratory support (Ped-RESCUERS). Intensive Care Med. 2016;42:879–88.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Zabrocki LA, Brogan TV, Statler KD, et al. Extracorporeal membrane oxygenation for pediatric respiratory failure: survival and predictors of mortality. Crit Care Med. 2011;39:364–70.

    Article  PubMed  Google Scholar 

  40. Gupta M, Shanley TP, Moler FW. Extracorporeal life support for severe respiratory failure in children with immune compromised conditions. Pediatr Crit Care Med. 2008;9:380–5.

    Article  PubMed  Google Scholar 

  41. DiNardo M, Locatelli F, Palmer K, et al. Extracorporeal membrane oxygenation in pediatric recipients of hematopoietic stem cell transplantation: an updated analysis of the extracorporeal life support organization experience. Intensive Care Med. 2014;40:754–6.

    Google Scholar 

  42. Cashen K, Thiagarajan RR, Collins JW, et al. Extracorporeal membrane oxygenation in pediatric trisomy 21: 30 years of experience from the extracorporeal life support organization. J Pediatr. 2015;167:403–8.

    Article  PubMed  Google Scholar 

  43. Fleming GM, Sahay R, Zappitelli M, et al. The incidence of acute kidney injury and its effect on neonatal and pediatric ECMO outcomes: a multicenter report from the KIDMO Study Group. Pediatr Crit Care Med. 2016;17:1157–69.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Aharon AS, Drinkwater DC, Churchwell KB, et al. Extracorporeal membrane oxygenation in children after repair of congenital cardiac lesions. Ann Thorac Surg. 2001;72:2095–101, discussion 2101–2102.

    Article  CAS  PubMed  Google Scholar 

  45. Morris MC, Ittenbach RF, Godinez RI, et al. Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation. Crit Care Med. 2004;32:1061–9.

    Article  PubMed  Google Scholar 

  46. Xiong H, Xia B, Zhu J, et al. Clinical outcomes in pediatric patients hospitalized with fulminant myocarditis requiring extracorporeal membrane oxygenation: a meta-analysis. Pediatr Cardiol. 2017;38:209–14.

    Article  PubMed  Google Scholar 

  47. Moler FW, Custer JR, Bartlett RH, et al. Extracorporeal life support for pediatric respiratory failure. Crit Care Med. 1992;20:1112–8.

    Article  CAS  PubMed  Google Scholar 

  48. Domico MB, Ridout DA, Bronicki R, et al. The impact of mechanical ventilation time before initiation of extracorporeal life support on survival in pediatric respiratory failure: a review of the extracorporeal life support registry. Pediatr Crit Care Med. 2012;13:16–21.

    Article  PubMed  Google Scholar 

  49. Paret G, Ziv T, Barzilai A, Ben-Abraham R, Vardi A, Manisterski Y, Barzilay Z. Ventilation index and outcome in children with acute respiratory distress syndrome. Pediatr Pulmonol. 1998;26(2):125–8.

    Article  CAS  PubMed  Google Scholar 

  50. Ghuman AK, Newth CJ, Khemani RG. The association between the end tidal alveolar dead space fraction and mortality in pediatric acute hypoxemic respiratory failure. Pediatr Crit Care Med. 2012;13(1):11–5.

    Article  PubMed  Google Scholar 

  51. Maslach-Hubbard A, Bratton SL. Extracorporeal membrane oxygenation for pediatric respiratory failure: history, development and current status. World J Crit Care Med. 2013;2:29–39.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Lin JC. Extracorporeal membrane oxygenation for severe pediatric respiratory failure. Respir Care. 2017;62:732–50.

    Article  PubMed  Google Scholar 

  53. Abrams D, Brodie D. Identification and management of recirculation in venovenous ECMO. LSO guidelines for cardiopulmonary extracorporeal life support and patient specific supplements to the ELSO general guidelines, Ann Arbor; May 2015.

    Google Scholar 

  54. Neto AS, Schmidt M, Azevedo LCP, et al. Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis. Mechanical ventilation during ECMO. Intensive Care Med. 2016;42:1672–84.

    Article  Google Scholar 

  55. Schmidt M, Stewart C, Bailey M, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study. Crit Care Med. 2015;43:654–64.

    Article  CAS  PubMed  Google Scholar 

  56. Anton-Martin P, Thompson MT, Sheeran PD, et al. Extubation during pediatric extracorporeal membrane oxygenation: a single center experience. Pediatr Crit Care Med. 2014;15:861–9.

    Article  PubMed  Google Scholar 

  57. Young G. Anticoagulation therapies in children. Pediatr Clin N Am. 2017;64:1257–69.

    Article  Google Scholar 

  58. Bembea MM, Schwartz JM, Shah N, et al. Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: an international survey. Pediatr Crit Care Med. 2013;14:e77–84.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Dalton HJ, Reeder R, Garcia-Filion P, et al. Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation. Am J Respir Crit Care Med. 2017;196:762–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Barton R, Ignjatovic V, Monagle P. Anticoagulation during ECMO in neonatal and paediatric patients. Thromb Res. 2018; May 8 [epub ahead of print].

    Google Scholar 

  61. Parker RL. How we measure anticoagulation is just as important (maybe more important) as how we anticoagulate. Pediatr Crit Care Med. 2014;15:786–8.

    Article  PubMed  Google Scholar 

  62. Liveris A, Bello RA, Friedmann P, et al. Anti-factor Xa assay is a superior correlate of heparin dose than activated partial thromboplastin time or activated clotting time in pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2014;15:e72–9.

    Article  PubMed  Google Scholar 

  63. Nguyen T, Muscik M, Teruya J. Anticoagulation monitoring during extracorporeal membrane oxygenation: is anti-factor Xa assay (heparin level) a better test? Pediatr Crit Care Med. 2014;15:178–9.

    Article  PubMed  Google Scholar 

  64. Venkatesh K, Nair PS, Hoechter DJ, Buscher H. Current limitations of the assessment of haemostasis in adult extracorporeal membrane oxygenation patients and the role of point-of-care testing. Anaesth Intensive Care. 2016;44:669–80.

    Article  CAS  PubMed  Google Scholar 

  65. Northrop MS, Sidonio RF, Phillips SE, et al. The use of an extracorporeal membrane oxygenation anticoagulation laboratory protocol is associated with decreased blood product use, decreased hemorrhagic complications, and increased circuit life. Pediatr Crit Care Med. 2015;16:66–74.

    Article  PubMed  Google Scholar 

  66. Bizzarro MJ, Conrad SA, Kaufman DA, et al. Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults. Pediatr Crit Care Med. 2011;12:277–81.

    Article  PubMed  Google Scholar 

  67. Kaczala GW, Paulus SC, Al-Dajani N, et al. Bloodstream infections in pediatric ECLS: usefulness of daily blood culture monitoring and predictive value of biological markers. The British Columbia experience. Pediatr Surg Int. 2009;25:169–73.

    Article  PubMed  Google Scholar 

  68. Fisser C, Malfertheiner MV. Infection and colonization in VV ECMO—not a predictor of poor outcome. J Thorac Dis. 2018;10:S2045–7.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Cashen K, Reeder R, Dalton HJ, et al. Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation. Perfusion. 2018;33(6):472–82; [epub ahead of print].

    Article  PubMed  PubMed Central  Google Scholar 

  70. Dalton HJ, Cashen K, Reeder RW, et al. Hemolysis during pediatric extracorporeal membrane oxygenation: associations with circuitry, complications, and mortality. Pediatr Crit Care Med. 2018;19(11):1067–76. [epub ahead of print].

    Article  PubMed  PubMed Central  Google Scholar 

  71. Lockie CJA, Gillon SA, Barrett NA, et al. Severe respiratory failure, extracorporeal membrane oxygenation, and intracranial hemorrhage. Crit Care Med. 2017;45:1642–9.

    Article  PubMed  Google Scholar 

  72. Kim K, Mazor RL, Rycus PT, Brogan TV. Use of venovenous extracorporeal life support in pediatric patients for cardiac indication: a review of the extracorporeal life support organization registry. Pediatr Crit Care Med. 2012;13:285–9.

    Article  PubMed  Google Scholar 

  73. Boyle K, Felling R, Yiu A, et al. Neurologic outcomes after extracorporeal membrane oxygenation—a systematic review. Pediatr Crit Care Med. 2018; [epub ahead of print].

    Google Scholar 

  74. Quasney MW, López-Fernández YM, Santschi M, Watson RS, Pediatric Acute Lung Injury Consensus Conference Group. The outcomes of children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5 Suppl 1):S118–31.

    Article  PubMed  Google Scholar 

  75. Yehya N, Thomas NJ. Relevant outcomes in pediatric acute respiratory distress syndrome studies. Front Pediatr. 2016;4:51.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Turi KN, Shankar J, Anderson LJ, Rajan D, Gaston K, Gebretsadik T, Das SR, Stone C, Larkin EK, Rosas-Salazar C, Brunwasser SM, Moore ML, Peebles RS Jr, Hartert TV. Infant viral respiratory infection nasal-immune-response patterns and their association with subsequent childhood recurrent wheeze. Am J Respir Crit Care Med. 2018;198(8):1064–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Stein RT, Sherrill D, Morgan WJ, Holberg CJ, Halonen M, Taussig LM, Wright AL, Martinez FD. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet. 1999;354(9178):541–5.

    Article  CAS  PubMed  Google Scholar 

  78. Als LC, Picouto MD, Hau SM, Nadel S, Cooper M, Pierce CM, Kramer T, Garralda ME. Mental and physical well-being following admission to pediatric intensive care. Pediatr Crit Care Med. 2015;16(5):e141–9.

    Article  PubMed  Google Scholar 

  79. Jen HC, Shew SP. Hospital readmissions and survival after nonneonatal ECMO. Pediatrics. 2010;125:1217–23.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Critical Care, Children’s Hospital of Richmond at VCU, Richmond, VA, USA

    Jesse C. Bain

  2. Division of Pediatric Critical Care, Department of Pediatrics, Children’s Hospital of Richmond at VCU, Richmond, VA, USA

    Doug Willson

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  1. Jesse C. Bain
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  2. Doug Willson
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Correspondence to Doug Willson .

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Editors and Affiliations

  1. Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH, USA

    Steven L. Shein

  2. Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA

    Alexandre T. Rotta

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Bain, J.C., Willson, D. (2020). ECMO for Pediatric Acute Respiratory Distress Syndrome (PARDS). In: Shein, S., Rotta, A. (eds) Pediatric Acute Respiratory Distress Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-030-21840-9_16

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  • DOI: https://doi.org/10.1007/978-3-030-21840-9_16

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