Update on ECMO in Update on ECMO in paediatric patients paediatric patients Gianluca Brancaccio MD, PhD Gianluca Brancaccio MD, PhD Ospedale Pediatrico Bambino Gesù, Rome, Italy Ospedale Pediatrico Bambino Gesù, Rome, Italy New Perspectives in ECMO 2012 New Perspectives in ECMO 2012 III International meeting, 5 October, 2012 Milan III International meeting, 5 October, 2012 Milan
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Update on ECMO in Update on ECMO in paediatric patientspaediatric patients
New Perspectives in ECMO 2012 New Perspectives in ECMO 2012 III International meeting, 5 October, 2012 MilanIII International meeting, 5 October, 2012 Milan
BackgroundBackground• ECLS is constantly improving since it was first used in ECLS is constantly improving since it was first used in
critically ill patients with respiratory failure over 40 years critically ill patients with respiratory failure over 40 years ago.ago.
• To date overTo date over 50.000 patients were treated50.000 patients were treated with ECMO, with ECMO, been neonates and infants the majority.been neonates and infants the majority.
• Aim of this overview is to illustrate the changing in Aim of this overview is to illustrate the changing in environment, equipment and management in ECLS over environment, equipment and management in ECLS over time.time.
ELSO Registry July 2012
Runs by Year
0%
20%
40%
60%
80%
100%
Card (16 years and over)
Card (1 year < 16 years)
Card (31 days < 1 year)
Card (0 - 30 days)
Adult Pulm
Ped Pulm
Neo Pulm
ELSO Registry July 2012
Neonatal Respiratory Cases
Clark RH et al. N Engl J Med 342: 469-474, 2000
ELSO Registry July 2012
Cumulative Survival in Neonatal Respiratory Support
- Triple lumen cannula - ↓ recirculation - Good flow dynamics- Sizes from 13 Fr to 31
Fr.
Conclusions• The field of ECMO is currently in a state of flux. Many
patients denied ECMO support in the past are now being considered for ECMO support and obtaining long-term survival.
• The experience and knowledge gained over the past 20 years or more of ECMO has resulted in making this therapy more accessible, safer, and efficient.
• The revised interest in use of ECMO in cardiac arrest, sepsis and other populations may herald an increase in the use of ECLS in future days.
Experience OPBG• A total of 93 veno-
arterial ECMOs were delivered to 90 patients: in 3 cases two separate ECMO sessions were necessary; 3 patients were bridged from ECMO to ventricular assist device
ECMO indications
• low cardiac output syndrome (LCOS) in 10 cases
• post-operative LCOS in 61 patients
• respiratory support in 20 children
• sepsis in 2 patients
Results
• Children who survived on ECMO had a significantly shorter treatment duration: 4 (2.7-7) vs. 9 (5.7-16) days p<0.0001
Results-2• Age, weight, RACHS
score, indication to treatment, pump type, cannulation site, need for renal replacement therapy and the presence of univentricular anatomy were not significantly associated with an increased ICU mortality (p>0.05).
ELSO Registry July 2012
Overall Patient Outcomes Total Surv ECLS Surv to DC
– Jugular-carotid– Femoro-femoral VA ECMO– Femoro-femoral VV ECMO
• Veno-venous vs. veno-arterial ECMO• Percutaneous cannulation
Results-3• However, a trend to
increased mortality was evident in RRT patients. Furthermore, in our patients, respiratory ECMOs showed a better chance to be weaned off than cardiac ECMOs (75% vs 43%, OR 3.8, 95% C.I. 1.7-11, p:0.01). However, ICU survival was not significantly different (55% vs 40%, OR 1.9, 95% C.I. 0.7-5.3, p:0.2).