Applications of extracorporeal membrane oxygenation in 9 critically ill children

258 DOI 10. 3969 /j. issn. 1673-5501. 2012. 04. 004 9 ECMO 2008 12 2012 5 9 ECMO 9 V-A ECMO ACT 180 ~ 220 s 50 ~ 100 ml kg - 1 min - 1 9 ECMO 5 ~ 280 h 112 h 8 ECMO 7 1 ECMO 3 d 1 ECMO 1 14 6 3 2 1 7 6 1 1 ECMO ECMO ECMO Applications of extracorporeal membrane oxygenation in 9 critically ill children CHENG Ye JIA Bin LIU Jiang-bin LU Guo-ping CAI Xiao-di HE Jun ZHONG Hui HU Jing ZHANG Yu-xia SUN Bo LU Zhu-jin Intensive Care Unit Children's Hospital of Fudan University Shanghai 201102 China Corresponding Author LU Zhu-jin E-mail zjlu19@ yahoo. com. cn Abstract Objective To retrospectively analyze the clinical application of extracorporeal membrance oxygenation ECMO support in 9 critically ill children who suffered from cardiac and / or pulmonary failure with no response to advanced treatment except ECMO or could not wean from cardiopulmonary bypass following cardiac surgery. Methods All 9 cases were collected from December 2008 to May 2012 in Children's Hospital of Fudan University and all received ECMO treatment. Four cases were from PICU and 5 were from CCU. Clinical data including age sex body weight disease clinical information before and after the treatment of ECMO and prognosis were reviewed. V-A ECMO was applied to all 9 cases after vessels cannulation or surgery. Heparin was given to each case to keep activated clotting time ACT between 180 and 220 seconds. Extracorporeal blood flow was set at 50-100 ml kg - 1 min - 1 during the treatment of ECMO. Vital signs including cardiac ultrasound chest X-ray and blood gas were monitored. Results The ECMO time varied from 5 to 280 hours with median of 112 h. All patients weaned from ECMO successfully after cardiopulmonary function recovered. Seven of 9 cases survived and discharged from hospital and 1 kid gave up the treatment after termination of ECMO. One child with ECMO finally died of post-operative cardiopulmonary failure accompanied by refractory septic shock and pulmonary hypertension crisis. There were 14 episodes of complications during the treatment of ECMO 6 of them were mechanical events such as leakage of oxygenator thrombosis developed in the ECMO tube system and heater machine failure. There were 6 body complications including anemia and difficulty in moving right upper limb. One case had a hematoma due to accidental misplace of the invasive artery blood pressure line during the treatment of ECMO. No cerebral complications or intracranial hemorrhage as well as infections were found. Conclusions ECMO is an effective access to give cardiac pulmonary support for critically ill children. A skillful and good cooperative ECMO team is important for safely and successfully running of ECMO. Key words Critically ill Children Extracorporeal membrane oxygenation Cardiac pulmonary support 201102 E-mail zjlu19@ yahoo. com. cn

2012 7 7 4 259 PICU V-14F A-10 ~ 12F CCU ECMO 1. 4 Hill 1972 1. 4. 1 ECMO 1 1976 Bartllet 1 ECMO ARDS 1. 4. 2 ECMO 9 V-A ECMO 50 ~ 100 ml kg - 1 min - 1 1 800 ~ 2 300 2 3 ELSO 2005 r min - 1 100% 1 ~ 2 L ECMO min - 1 800 200 1. 4. 3 50 ~ 100 U kg - 1 5 ~ 10 U ECMO 77% kg - 1 h - 1 ACT 38% ECMO ACT 180 ~ 220 s 2004 1. 4. 4 ECMO SIMV PEEP 3 cmh 2 O RR < 20 ECMO 2008 min - 1 FiO 2 < 0. 50 VT 3 ml kg - 1 ECMO 2011 12 PICU 1. 4. 5 ECMO FiO 2 ECMO ECMO SVO 2 0. 65 ~ 0. 75 1 1. 1 2008 12 2012 5 PICU CCU 9 ECMO 6 X 3 2 ~ 52 15. 8 ± 54. 4 5 24 h X CCU 4 PICU CT 1. 4. 6 ECMO 1 1. 2 ECMO 6 h 1 FiO 2 0. 60 2PEEP 5 cmh 2 O 3 1. 2. 1 ECMO 4 < 2 L m - 2 min - 1 0. 5 ml cm - 1 kg - 1 2 > 15 μg kg - 1 min - 1 > 0. 1 μg kg - 1 min - 1 > 0. 1 < 10 μg kg - 1 h - 1 SVO 2 μg kg - 1 min - 1 < 60 mmhg 1 mmhg = 0. 133 kpa < 0. 5 ml kg - 1 h - 1 1 ~ 2 h 1 1. 2. 2 ECMO 5 OI 40 4 h - 12 h PaO 2 < 40 mmhg 2 h P A-a O 2 > 600 1. 2. 3 6 < 2 kg 10 ~ 14 d 1. 5. 1 3 1 2 OI 39. 3 2 1. 3 1. 3. 1 Medtronic 3 EV71 OI 35. 4 EF 42% BP 75 /35 Bio-Console 560 MINIMAX PLUS mmhg 2 Medtronic 8F 1 10F 12F 14F / Hb > 110 g L - 1 Hct > 0. 30 38 ~ 38. 5 MAP CVP PaO 2 SpO 2 SaO 2 > 0. 90 PaCO 2 < 50 mmhg 4 < 10% V-A ECMO > 0. 70 EF > 0. 40 CVP 12 mmhg 10% ~ 20% < 20 ml kg - 1 < 0. 2 L min - 1 ECMO 1. 5 PaO 2 < 40 mm Hg 2 h OI 35. 4 SpO 2 1. 5. 2 ECMO 3 ECMO 1. 3. 2 4 3 1 SpO 2 PaO 2 PaO 2 /FiO 2 P /F OI 5 PEEP PIP FiO 2 X 4 1 3 1

260 Case Age / months Sex Tab 1 Weight /kg 1 ECMO 3 Data of 3 patients suffered from pulmonary failure who received ECMO treatment Disease PaO 2 /mmhg OI PaO 2 /FiO 2 FiO 2 /% ECMO time /h gnosis 1 7 Male 8 Measles pneumonia 50. 8 95. 0 39. 3 6. 94 114 317 0. 85 0. 30 158 Cured 2 52 Male 19 Plastic bronchitis 72. 3 135 35. 4 5. 93 72. 3 338 1. 0 0. 40 120 Cured 3 44 Male 18 Critical HFM disease 40. 9 125 35. 4 4. 81 102 417 0. 50 0. 30 71 Survived Notes OI Oxygenation index HFM hand-foot-mouth pre before the treatment of ECMO pro after the treatment of ECMO 1. 6 1. 6. 1 6 5 X 3 CCU 4 4 ~ 7 4 6 7 5 ~ 14 h 4 1 8 EF 0. 403 ± 0. 215 1 8 1 1 ECMO 1 9 PICU ECMO 1 h EF 0. 29 FS 1 9 0. 13 2 1. 6. 2 ECMO 4 4 ~ 7 ECMO MAP EF ECMO 2 Tab 2 2 ECMO 6 Data of 6 patients suffered from cardiac failure who received ECMO treatment Case Age / Weight MAP /mmhg Lac /mmol L - 1 EF /% ECMO Sex Disease months /kg time /h gnosis 4 3 M 4. 5 After operation of ALCAPA 48. 0 51. 3 2. 80 1. 10 0. 27 0. 66 14 Cured 5 21 M 9 After operation of TGA + ASD + PDA 36. 3 70. 3 8. 70 3. 60 0. 24 0. 57 171 Cured 6 6 F 5 After operation of TGA + PDA 44. 0 61. 7 2. 70 1. 80 0. 39 0. 64 14 Cured 7 4 F 5 After operation of TAPVD + ASD + PDA + PH 43. 7 60. 7 2. 10 1. 50 0. 71 0. 82 5 Cured 8 2 M 5 After operation of VSD + PH 38. 7 75. 7 7. 60 1. 00 0. 69 0. 70 280 Dead 9 3 F 5 DCM + pneumonia 50. 0 68. 0 9. 60 0. 90 0. 29 0. 43 112 Automatic discharge Notes M male F female MAP mean arterial pressure Lac lactic acid EF cardiac ejection fraction DCM dilated cardiomyopathy ALCAPA anomalous origin of the left coronary artery from the pulmonary artery ASD atrial septal defect VSD ventricular septal defect PH pulmonary artery hypertension TGA transposition of the great arteries PDA patent ductus arteriosus TAPVD total anomalous pulmonary venous drainage pre before the treatment of ECMO pro after the treatment of ECMO 1. 7 14 2 6 3 ECMO 3 5 2 CO 2 ECMO 1 ECMO 50% 7 8 ECMO 7 6 1 60% 1 49% 2008 ECMO ECMO 5 4 ~ 8 4 4 ~ 7 ECMO

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