Extracorporeal Membrane Oxygenation for Pertussis: Predictors of Outcome Including Pulmonary Hypertension and Leukodepletion

Objective: The recent increase of pertussis cases worldwide has generated questions regarding the utility of extracorporeal membrane oxygenation for children with pertussis. We aimed to evaluate factors associated with extracorporeal membrane oxygenation outcome. Design: The study was designed in two parts: a retrospective analysis of the Extracorporeal Life Support Organization Registry to identify factors independently linked to outcome, and an expanded dataset from individual institutions to examine the association of WBC count, pulmonary hypertension, and leukodepletion with survival. Setting: Extracorporeal Life Support Organization Registry database from 2002 though 2015, and contributions from 19 international centers. Patients: Two hundred infants from the Extracorporeal Life Support Organization Registry and expanded data on 73 children. Interventions: None. Measurements and Main Results: Of the 200 infants who received extracorporeal membrane oxygenation for pertussis, only 56 survived (28%). In a multivariable logistic regression analysis, the following variables were independently associated with increased chance of survival: older age (odds ratio, 1.43 [1.03–1.98]; p = 0.034), higher Pao2/Fio2 ratio (odds ratio, 1.10 [1.03–1.17]; p = 0.003), and longer intubation time prior to the initiation of extracorporeal membrane oxygenation (odds ratio, 2.10 [1.37–3.22]; p = 0.001). The use of vasoactive medications (odds ratio, 0.33 [0.11–0.99]; p = 0.047), and renal neurologic or infectious complications (odds ratio, 0.21 [0.08–0.56]; p = 0.002) were associated with increased mortality. In the expanded dataset (n =73), leukodepletion was independently associated with increased chance of survival (odds ratio, 3.36 [1.13–11.68]; p = 0.03) while the presence of pulmonary hypertension was adverse (odds ratio, 0.06 [0.01–0.55]; p = 0.01). Conclusions: The survival rate for infants with pertussis who received extracorporeal membrane oxygenation support remains poor. Younger age, lower Pao2/Fio2 ratio, vasoactive use, pulmonary hypertension, and a rapidly progressive course were associated with increased mortality. Our results suggest that pre–extracorporeal membrane oxygenation leukodepletion may provide a survival advantage

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery:a systematic review and meta-analysis

Background - Postcardiotomy cardiogenic shock (PCCS) refractory to inotropic support and intra-aortic balloon pump (IABP) occurs rarely but is almost universally fatal without mechanical circulatory support. In this systematic review and meta-analysis we looked at the evidence behind the use of veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in refractory PCCS from a patient survival rate and determinants of outcome viewpoint. Methods - A systematic review was performed in January 2017 using PubMed (with no defined time period) using the keywords “postcardiotomy”, “cardiogenic shock”, “extracorporeal membrane oxygenation” and “cardiac surgery”. We excluded papers pertaining to ECMO following paediatric cardiac surgery, medical causes of cardiogenic shock, as well as case reports, review articles, expert opinions, and letters to the editor. Once the studies were collated, a meta-analysis was performed on the proportion of survivors in those papers that met the inclusion criteria. Meta-regression was performed for the most commonly reported adverse prognostic indicators (API). Results - We identified 24 studies and a cumulative pool of 1926 patients from 1992 to 2016. We tabulated the demographic data, including the strengths and weaknesses for each of the studies, outcomes of VA ECMO for refractory PCCS, complications, and APIs. All the studies were retrospective cohort studies. Meta-analysis of the moderately heterogeneous data (95% CI 0.29 to 0.34, p 70 years, 95% CI −0.057 to 0.001, P = 0.058), and long ECMO support (95% CI −0.068 to 0.166, P = 0.412). Postoperative renal failure, high EuroSCORE (>20%), diabetes mellitus, obesity, rising lactate whilst on ECMO, gastrointestinal complications had also been reported. Conclusion - Haemodynamic support with VA ECMO provides a survival benefit with reasonable intermediate and long-term outcomes. Many studies had reported advanced age, renal failure and prolonged VA ECMO support as the most likely APIs for VA ECMO in PCCS. EuroSCORE can be utilized to anticipate the need for prophylactic perioperative VA ECMO in the high-risk category. APIs can be used to aid decision-making regarding both the institution and weaning of ECMO for refractory PCCS

Hematologic concerns in extracorporeal membrane oxygenation

This ISTH "State of the Art" review aims to critically evaluate the hematologic considerations and complications in extracorporeal membrane oxygenation (ECMO). ECMO is experiencing a rapid increase in clinical use, but many questions remain unanswered. The existing literature does not address or explicitly state many pertinent details that may influence hematologic complications and, ultimately, patient outcomes. This review aims to broadly introduce modern ECMO practices, circuit designs, circuit materials, hematologic complications, transfusion-related considerations, age- and size-related differences, and considerations for choosing outcome measures. Relevant studies from the 2019 ISTH Congress in Melbourne, which further advanced our understanding of these processes, will also be highlighted

Extracorporeal membrane oxygenation for pertussis: Predictors of outcome including pulmonary hypertension and leukodepletion

10.1097/PCC.0000000000001454Pediatric Critical Care Medicine193254-26

Mechanical component failures in 28,171 neonatal and pediatric extracorporeal membrane oxygenation courses from 1987 to 2006

Objective: To provide a descriptive summary of mechanical component failure associated with extracorporeal membrane oxygenation (ECMO), and to examine patient and ECMO variables that may be associated with mechanical component failure and guide further study. We hypothesized that duration of ECMO, era of ECMO, indication for ECMO, age of patient, and center ECMO volume would be associated with mechanical component failure. Design: Retrospective cohort study. Patients and Methods: Extracorporeal Life Support Organization registry was queried for all neonatal and pediatric ECMO courses recorded. Each ECMO course was treated as an independent event, and was included if duration was ≥25 hrs with occurrence between 1987 and 2007. Courses with a duration \u3e458 hrs or with an indication for ECMO during cardiopulmonary resuscitation were excluded from analysis. Mechanical component failure data were extracted from the Extracorporeal Life Support Organization registry for the oxygenator, raceway, other tubing, pigtail connectors, heat exchanger, and air in the circuit. Results: A total of 28,171 independent ECMO courses were included for analysis, of which 14.9% were associated with a mechanical component failure. Duration of ECMO, age group of patient, era of ECMO, and indication for ECMO were all associated with mechanical component failure. From our predictive model, we observed a continuous nonlinear relation suggesting increasing probability of mechanical component failure with increasing duration of ECMO support. Conclusions: Mechanical component failure over the course of this study was infrequent during neonatal and pediatric ECMO, and declined across eras as experience with the therapy grew. Increasing duration of ECMO was associated with an increasing probability of mechanical component failure. Indication for ECMO and patient age were also statistically associated with mechanical component failure probability, but ECMO center volume was not. © 2009 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Hydrothermal zircons : A tool for ion microprobe U–Pb dating of precious metals mineralization in polyphased deposits

International audienc

The Tamlalt-Menhouhou gold deposit (eastern High-Atlas, Morocco) : a model of a polyphased deposit in a polymetallic area

International audienc