Pediatr Crit Care Me
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Pediatr Crit Care Me · Jun 2013
ReviewClinical management of the extracorporeal membrane oxygenation circuit.
The clinical management of patients on extracorporeal membrane oxygenation should be standardized and follow clear guidelines or protocols. However, due to the diversity of cannulation strategies and the complex situations that extracorporeal membrane oxygenation is now used in, each extracorporeal membrane oxygenation program has developed its own clinical management strategies. These vary widely across the globe. ⋯ Improvements in technology and greater understanding of disease pathophysiology, coupled to refinements in technology, which lessen the adverse interaction between the circuit and the patient, all contribute to fewer mechanical and patient complications on extracorporeal membrane oxygenation. Earlier and more appropriate use of extracorporeal membrane oxygenation has been associated with improved patient outcomes. These clinical management strategies are reviewed in this article, part of the Pediatric Cardiac Intensive Care Society/Extracorporeal Life Support Organization Joint Statement on Mechanical Circulatory Support.
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Mechanical circulatory support is an invaluable tool in the care of children with severe refractory cardiac failure. As the field of mechanical circulatory support has evolved in children, the frequency of ventricular assist device use has been increasing steadily with excellent results. Ventricular assist devices are being used with increasing frequency in children with cardiac failure refractory to medical therapy for primary treatment as a long-term bridge to recovery or transplantation. This review, part of the Pediatric Cardiac Intensive Care Society/Extracorporeal Life Support Organization Joint Consensus Statement on Mechanical Circulatory Support, focuses on ventricular assist device implantation and management, as well as anticipation and management of complications.
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Pediatr Crit Care Me · Jun 2013
Acute kidney injury based on corrected serum creatinine is associated with increased morbidity in children following the arterial switch operation.
Evaluate risk factors for and impact of acute kidney injury on children following the arterial switch operation. ⋯ Acute kidney injury following the arterial switch operation is associated with increased morbidity. In this single center, single population, and homogenous cohort of patients, the development of acute kidney injury was not correlated with age, size, or cardiopulmonary bypass time, but was still associated with prolonged duration of ventilation and hospitalization. Notably, the failure to correct serum creatinine for fluid balance underestimates the prevalence and impact of acute kidney injury.
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Pediatr Crit Care Me · Jun 2013
ReviewAnticoagulation for pediatric mechanical circulatory support.
Extracorporeal life support applications have evolved considerably in recent years. However, the blood-biomaterial interface remains incompletely understood, and management of the acute inflammatory response and coagulation pathways continues to be challenging. At present, the gold standard for anticoagulation is unfractionated heparin. ⋯ To address this, the Extracorporeal Life Support Organization has formed an Anticoagulation Task Force to help direct both a consensus statement and potential guidelines within which the multiple monitoring methods can be customized for extracorporeal life support. One key question that remains in the use of these monitoring methods is whether the objective during extracorporeal life support is to anticoagulate the circuit to prevent thrombus formation within the extracorporeal device or whether it is to systemically anticoagulate the patient. This review details all current monitoring methods and highlights how they can be used during pediatric mechanical circulatory support.
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Partial mechanical support devices are capable of partially unloading only one ventricle, often the systemic one, in the setting of acute circulatory failure. They are rarely used in the pediatric population, as the mode of circulatory failure in patients with congenital heart disease often involves biventricular or a predominantly right ventricular component. ⋯ They are rarely used as a bridge-to-recovery, but more often as a bridge-to-decision, or bridge-to-conversion to full mechanical support systems, such as extracorporeal membrane oxygenation or ventricular assist devices. Currently, lack of availability of more complete support devices, cost issues, or lack of infrastructure and personnel may still be indications to continue using partial mechanical support as opposed to more complete forms of biventricular circulatory support.