Acute Compartment Syndrome in Pediatric Patients on Extracorporeal Membrane Oxygenation Support.

Autor:	Bridges CS; Departments of Orthopedics., Taylor TN; Departments of Orthopedics., Bini T; Baylor College of Medicine, Houston, TX., Ontaneda AM; Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine., Coleman RD; Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine., Hill JF; Departments of Orthopedics., Montgomery NI; Departments of Orthopedics., Shenava VR; Departments of Orthopedics., Gerow FT; Departments of Orthopedics.
Jazyk:	angličtina
Zdroj:	Journal of pediatric orthopedics [J Pediatr Orthop] 2024 Mar 01; Vol. 44 (3), pp. e285-e291. Date of Electronic Publication: 2023 Dec 12.
DOI:	10.1097/BPO.0000000000002592
Abstrakt:	Background: When acute compartment syndrome (ACS) occurs in pediatric patients requiring venoarterial extracorporeal membrane oxygen (VA ECMO) support, there is little data to guide surgeons on appropriate management. The purpose of this study is to characterize the presentation, diagnosis, timeline, and outcomes of patients who developed this complication. Methods: This is a single-center retrospective case series of children below 19 years old on VA ECMO support who subsequently developed extremity ACS between January 2016 and December 2022. Outcomes included fasciotomy findings, amputation, mortality, and documented function at the last follow-up. Results: Of 343 patients on VA ECMO support, 18 (5.2%) were diagnosed with ACS a median 29 hours after starting ECMO. Initial cannulation sites included 8 femoral, 6 neck, and 4 central. Femoral artery cannulation was associated with an increased risk of ACS [odds ratio=6.0 (CI: 2.2 to 15), P <0.0001]. In the hospital, the mortality rate was 56% (10/18). Fourteen (78%) patients received fasciotomies a median of 1.2 hours after ACS diagnosis. Only 4 (29%) patients had all healthy muscles at initial fasciotomy, while 9 (64%) had poor muscular findings in at least 1 compartment. Patients with worse findings at fasciotomy had a significantly longer duration between ischemia onset and ACS diagnosis. Patients required a median of 1.5 additional procedures after fasciotomy, and only 1 (7%) developed a surgical site infection. Of the 7 surviving fasciotomy patients, 2 required amputations, 3 developed an equinus contracture, 1 developed foot drop, and 3 had no ACS-related deficits. Four patients did not receive fasciotomies: 3 were deemed too ill and later died, and 1 was diagnosed too late to benefit. The only surviving nonfasciotomy patient required bilateral amputations. Conclusions: Pediatric ECMO-associated ACS is not exclusive to patients with femoral artery cannulation. The majority of fasciotomy patients were diagnosed with ACS after muscle necrosis had already started. We were unable to definitively conclude whether fasciotomies provide better outcomes. There is a need for increased awareness and earlier recognition of this rare yet potentially devastating complication. Level of Evidence: Level IV-retrospective case series. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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