Use of ECMO support in pediatric patients with severe thoracic trauma
| Autor: | Madison M. Hunt, Pamela S. Ropski, Eric R. Scaife, Stephen J. Fenton, Katie W. Russell |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Thoracic Injuries medicine.medical_treatment 03 medical and health sciences 0302 clinical medicine Extracorporeal Membrane Oxygenation 030225 pediatrics Extracorporeal membrane oxygenation medicine Humans Glasgow Coma Scale Child Thoracic trauma Retrospective Studies Paraplegia Venous Thrombosis Hematoma business.industry Neck hematoma Infant General Medicine Length of Stay medicine.disease Dysphonia Surgery Stroke Venous thrombosis surgical procedures operative Muscle Spasticity 030220 oncology & carcinogenesis Child Preschool Pediatrics Perinatology and Child Health Cohort Abbreviated Injury Scale Female business Complication Withdrawal of care |
| Zdroj: | Journal of pediatric surgery. 54(11) |
| ISSN: | 1531-5037 |
| Popis: | Background Extracorporeal membrane oxygenation (ECMO) has been used in the non-trauma setting for over 30 years. However, the use of ECMO in trauma remains a difficult question, as the risk of bleeding must be weighed against the benefits of cardiopulmonary support. Methods Retrospective review of children who sustained severe thoracic trauma (chest abbreviated injury score ≥ 3) and required ECMO support between 2009 and 2016. Results Of the 425 children who experienced severe thoracic trauma, 6 (1.4%) underwent ECMO support: 67% male, median age 4.8 years, median ISS 36, median GCS 3, and overall survival 83%. The median hospital day of ECMO initiation was 2 with a median ECMO duration of 7 days. All cannulations occurred through the right neck regardless of the size of the child. Five initially had veno-venous support with 1 requiring conversion to veno-arterial (VA) support. Both children on VA support suffered devastating cerebrovascular accidents, one of which ultimately led to withdrawal of care and death. Complications in the cohort included: paraplegia (1), neurocognitive defects/dysphonia (1), infected neck hematoma (1), deep femoral venous thrombosis (1), bilateral lower extremity spasticity (1). Conclusion This small cohort supports the use of ECMO in children with severe thoracic injuries as a potentially lifesaving intervention, however, not without significant complication. Level of Evidence IV. |
| Databáze: | OpenAIRE |
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