PMID- 37462429
OWN - NLM
STAT- MEDLINE
DCOM- 20240104
LR  - 20240301
IS  - 1529-7535 (Print)
IS  - 1529-7535 (Linking)
VI  - 25
IP  - 1
DP  - 2024 Jan 1
TI  - Venovenous Extracorporeal Membrane Oxygenation Initiation for Pediatric Acute 
      Respiratory Distress Syndrome With Cardiovascular Instability is Associated With 
      an Immediate and Sustained Decrease in Vasoactive-Inotropic Scores.
PG  - e41-e46
LID - 10.1097/PCC.0000000000003325 [doi]
AB  - OBJECTIVE: To determine the association of venovenous extracorporeal membrane 
      oxygenation (VV-ECMO) initiation with changes in vasoactive-inotropic scores 
      (VISs) in children with pediatric acute respiratory distress syndrome (PARDS) and 
      cardiovascular instability. DESIGN: Retrospective cohort study. SETTING: Single 
      academic pediatric ECMO center. PATIENTS: Children (1 mo to 18 yr) treated with 
      VV-ECMO (2009-2019) for PARDS with need for vasopressor or inotropic support at 
      ECMO initiation. MEASUREMENTS AND MAIN RESULTS: Arterial blood gas values, VIS, 
      mean airway pressure (mPaw), and oxygen saturation (Sp o2 ) values were recorded 
      hourly relative to the start of ECMO flow for 24 hours pre-VV-ECMO and 
      post-VV-ECMO cannulation. A sharp kink discontinuity regression analysis 
      clustered by patient tested the difference in VISs and regression line slopes 
      immediately surrounding cannulation. Thirty-two patients met inclusion criteria: 
      median age 6.6 years (interquartile range [IQR] 1.5-11.7), 22% immunocompromised, 
      and 75% had pneumonia or sepsis as the cause of PARDS. Pre-ECMO characteristics 
      included: median oxygenation index 45 (IQR 35-58), mPaw 32 cm H 2o (IQR 30-34), 
      97% on inhaled nitric oxide, and 81% on an advanced mode of ventilation. Median 
      VIS immediately before VV-ECMO cannulation was 13 (IQR 8-25) with an overall 
      increasing VIS trajectory over the hours before cannulation. VISs decreased and 
      the slope of the regression line reversed immediately surrounding the time of 
      cannulation (robust p < 0.0001). There were pre-ECMO to post-ECMO cannulation 
      decreases in mPaw (32 vs 20 cm H 2o , p < 0.001) and arterial P co2 (64.1 vs 
      50.1 mm Hg, p = 0.007) and increases in arterial pH (7.26 vs 7.38, p = 0.001), 
      arterial base excess (2.5 vs 5.2, p = 0.013), and SpO 2 (91% vs 95%, p = 0.013). 
      CONCLUSIONS: Initiation of VV-ECMO was associated with an immediate and sustained 
      reduction in VIS in PARDS patients with cardiovascular instability. This VIS 
      reduction was associated with decreased mPaw and reduced respiratory and/or 
      metabolic acidosis as well as improved oxygenation.
CI  - Copyright (c) 2023 by the Society of Critical Care Medicine and the World 
      Federation of Pediatric Intensive and Critical Care Societies.
FAU - Chilcote, Daniel
AU  - Chilcote D
AD  - Division of Critical Care Medicine, Department of Anesthesiology and Critical 
      Care Medicine, Perelman School of Medicine, University of Pennsylvania, The 
      Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Sriram, Anant
AU  - Sriram A
AD  - Division of Critical Care Medicine, Department of Anesthesiology and Critical 
      Care Medicine, Perelman School of Medicine, University of Pennsylvania, The 
      Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Slovis, Julia
AU  - Slovis J
AD  - Division of Critical Care Medicine, Department of Anesthesiology and Critical 
      Care Medicine, Perelman School of Medicine, University of Pennsylvania, The 
      Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Morgan, Ryan W
AU  - Morgan RW
AD  - Division of Critical Care Medicine, Department of Anesthesiology and Critical 
      Care Medicine, Perelman School of Medicine, University of Pennsylvania, The 
      Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Schaubel, Douglas E
AU  - Schaubel DE
AD  - Department of Biostatistics, Epidemiology and Informatics, Perelman School of 
      Medicine at the University of Pennsylvania, Philadelphia, PA.
FAU - Connelly, James
AU  - Connelly J
AD  - ECMO Center, The Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Berg, Robert A
AU  - Berg RA
AD  - Division of Critical Care Medicine, Department of Anesthesiology and Critical 
      Care Medicine, Perelman School of Medicine, University of Pennsylvania, The 
      Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Keim, Garrett
AU  - Keim G
AD  - Division of Critical Care Medicine, Department of Anesthesiology and Critical 
      Care Medicine, Perelman School of Medicine, University of Pennsylvania, The 
      Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Yehya, Nadir
AU  - Yehya N
AD  - Division of Critical Care Medicine, Department of Anesthesiology and Critical 
      Care Medicine, Perelman School of Medicine, University of Pennsylvania, The 
      Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Kilbaugh, Todd
AU  - Kilbaugh T
AD  - Division of Critical Care Medicine, Department of Anesthesiology and Critical 
      Care Medicine, Perelman School of Medicine, University of Pennsylvania, The 
      Children's Hospital of Philadelphia, Philadelphia, PA.
AD  - ECMO Center, The Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Himebauch, Adam S
AU  - Himebauch AS
AD  - Division of Critical Care Medicine, Department of Anesthesiology and Critical 
      Care Medicine, Perelman School of Medicine, University of Pennsylvania, The 
      Children's Hospital of Philadelphia, Philadelphia, PA.
AD  - ECMO Center, The Children's Hospital of Philadelphia, Philadelphia, PA.
LA  - eng
GR  - R01 HL147616/HL/NHLBI NIH HHS/United States
GR  - RL1 HD107777/HD/NICHD NIH HHS/United States
GR  - K23 HL153759/HL/NHLBI NIH HHS/United States
GR  - K23 HL148541/HL/NHLBI NIH HHS/United States
GR  - R01 HL148054/HL/NHLBI NIH HHS/United States
GR  - R01 DK070869/DK/NIDDK NIH HHS/United States
PT  - Journal Article
DEP - 20230718
PL  - United States
TA  - Pediatr Crit Care Med
JT  - Pediatric critical care medicine : a journal of the Society of Critical Care 
      Medicine and the World Federation of Pediatric Intensive and Critical Care 
      Societies
JID - 100954653
SB  - IM
MH  - Humans
MH  - Child
MH  - *Extracorporeal Membrane Oxygenation
MH  - Retrospective Studies
MH  - *Respiratory Distress Syndrome/therapy
MH  - *Respiratory Insufficiency/therapy
MH  - Arteries
PMC - PMC10768839
MID - NIHMS1910748
COIS- Dr. Keim received an institutional grant. Grant funding was paid to the 
      affiliated institutions in support of the ongoing work of Drs. Morgan (National 
      Institutes of Health [NIH] National Heart, Lung, and Blood Institute [NHLBI] 
      K23-HL148541), Berg (NIH 5R01HL147616-03, NIH 1RL1HD107777-01), Yehya (NIH NHLBI 
      5R01HL148054-03), Schaubel (NIH NIDDK R01-DK070869), and Himebauch (NIH NHLBI 
      K23-HL153759). Dr. Himebauch's institution received funding from the NHLBI. Drs. 
      Himebauch, Sriram, and Morgan received support for article research from the NIH. 
      Dr. Sriram's institution received funding from the NHBLI (K23-HL153759). Dr. 
      Morgan's institution received funding from the NHBLI (K23HL148541). Dr. Yehya's 
      institution received funding from Pfizer. The remaining authors have disclosed 
      that they do not have any potential conflicts of interest.
EDAT- 2023/07/18 13:07
MHDA- 2024/01/04 11:43
PMCR- 2025/01/01
CRDT- 2023/07/18 09:33
PHST- 2025/01/01 00:00 [pmc-release]
PHST- 2024/01/04 11:43 [medline]
PHST- 2023/07/18 13:07 [pubmed]
PHST- 2023/07/18 09:33 [entrez]
AID - 00130478-202401000-00017 [pii]
AID - 10.1097/PCC.0000000000003325 [doi]
PST - ppublish
SO  - Pediatr Crit Care Med. 2024 Jan 1;25(1):e41-e46. doi: 
      10.1097/PCC.0000000000003325. Epub 2023 Jul 18.