Open abdomen during extracorporeal membrane oxygenation is a safe and effective treatment for abdominal compartment syndrome
| Autor: | Joshua W. Brown, Brielle Warnock, Matthew L Friedman, Brian W. Gray, Michael J. Hobson, Eamaan Turk |
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| Rok vydání: | 2022 |
| Předmět: |
Inotrope
medicine.medical_specialty Abdominal compartment syndrome medicine.medical_treatment Extracorporeal Membrane Oxygenation Abdomen Extracorporeal membrane oxygenation Humans Medicine Effective treatment Respiratory system Child Open abdomen Retrospective Studies business.industry Abdominal Cavity General Medicine medicine.disease Surgery body regions Treatment Outcome surgical procedures operative medicine.anatomical_structure Pediatrics Perinatology and Child Health Cohort Intra-Abdominal Hypertension business |
| Zdroj: | Journal of Pediatric Surgery. 57:216-222 |
| ISSN: | 0022-3468 |
| Popis: | Background/Purpose Decompressive laparotomy and open abdomen for abdominal compartment syndrome have been historically avoided during Extracorporeal Membrane Oxygenation (ECMO) due to seemingly elevated risks of bleeding and infection. Our goal was to evaluate a cohort of pediatric respiratory ECMO patients who underwent decompressive laparotomy with open abdomen at a single institution and to compare these patients to ECMO patients without open abdomen. Methods We reviewed all pediatric respiratory ECMO (30 days-18 years) patients treated with decompressive laparotomy with open abdomen at Riley Hospital for Children (1/2000-12/2019) and compared these patients to concurrent respiratory ECMO patients with closed abdomen. We excluded patients with surgical cardiac disease. We assessed demographics, ECMO data, and outcomes and defined significance as p=0.05. Results 6 of 81 ECMO patients were treated with decompressive laparotomy and open abdomen. Open and closed abdomen groups had similar age (p=0.223) and weight (0.286) at cannulation, but the open abdomen group had a higher reliance on vasoactive medications (Vasoactive Inotropic Score, p=0.040). Open abdomen group survival was similar to closed abdomen patients (66.7%, vs 62.7%, p=1). Open abdomen patients had lower incidence of ECMO complications (33.3% vs 83.6%, p=0.014), but the groups had similar bleeding complications (p=0.412) and PRBC transfusion volume (p=0.941). Conclusion/Impact Pediatric ECMO patients with open abdomen after decompressive laparotomy had similar survival, blood products administered, and complications as those with a closed abdomen. An open abdomen is not a contra-indication to ECMO support in pediatric respiratory patients and should be considered in select patients. |
| Databáze: | OpenAIRE |
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