| Popis: |
Pediatric veno-arterial extracorporeal membrane oxygenation (V-A ECMO) was first used in the 1970s in patients with postcardiotomy shock. In the subsequent decades, improving outcomes in the postcardiac surgery patient have led to increased V-A ECMO use in ever-widening scenarios and for a variety of indications. Given the very poor outcomes of in-hospital cardiac arrest treated with traditional cardiopulmonary resuscitation (CPR) in children, extracorporeal cardiopulmonary resuscitation (ECPR) has become a viable treatment modality with improved survival to hospital discharge. Children in particular pose a significant therapeutic challenge given their variable size, weight, and wide-ranging etiology of the cardiac arrest. Favorable outcomes after ECPR depend on a wide range of factors, both patient and system dependent. Success depends on the establishment of a sound ECMO program, including established criteria for ECMO team activation, efficient mobilization of resources, standardized cannulation strategies and technique, evidence-based postimplant management protocol, including anticoagulation management, prompt complication management, and preestablished V-A ECMO weaning criteria. In conclusion, ECPR provides superior outcomes compared to traditional CPR. High morbidity and mortality remain a challenge, providing ample opportunity for continued improvement. |
