title: The use of extracorporeal membrane oxygenation in pediatric patients with sickle cell disease.
abstract: Previous reports have described the use of extracorporeal membrane oxygenation (ECMO) for acute chest syndrome of sickle cell disease (SCD). However, there have been no reports of venoarterial (VA) ECMO for cardiac dysfunction in patients with SCD. We describe a patient with SCD and life-threatening cardiogenic shock who was successfully treated with VA ECMO. Furthermore, SCD patients have unique comorbidities that warrant particular consideration when utilizing ECMO. We discuss these considerations and review the documented experience with ECMO for pediatric SCD patients from the Extracorporeal Life Support Organization (ELSO) registry. From 1990 until 2012, 52% of the 65 pediatric patients with SCD placed on ECMO survived, with 85% of those receiving venovenous (VV) ECMO surviving and 43% of those receiving VA ECMO surviving. However, significant complications, such as bleeding, neurological injury and kidney injury, also occurred with both VV and VA ECMO. Ten percent of SCD patients receiving VA ECMO experienced either a cerebral infarct or hemorrhage; our patient suffered a cerebrovascular accident while on ECMO, though she survived with good neurologic outcome. To our knowledge, this is the first report of a pediatric patient with SCD and cardiogenic shock successfully managed with VA ECMO. In conjunction with the ELSO registry review, this case report suggests that, while VA ECMO can be successfully used in patients with SCD and severe cardiovascular dysfunction, clinicians should also be aware of the potential for serious complications in this high-risk population.
authors: Department of Pediatrics and Communicable Diseases, Division of Critical Care, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI 48109, USA. kkevin@med.umich.edu
authors: K W
authors: KW
authors: Kuo
authors: T T
authors: TT
authors: Cornell
authors: T P
authors: TP
authors: Shanley
authors: F O
authors: FO
authors: Odetola
authors: G M
authors: GM
authors: Annich
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D012042:Registries; D012770:Shock, Cardiogenic / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome
keywords: acute chest syndrome; cardiogenic shock; extracorporeal membrane oxygenation; sepsis; sickle cell disease
references: Ann Thorac Surg. 2012 Sep;94(3):874-9; discussion 879-80
references: 22698774
references: J Pediatr Surg. 2012 Jan;47(1):68-75
references: 22244395
references: Br Med J (Clin Res Ed). 1987 Jan 10;294(6564):81-2
references: 3105665
references: ASAIO J. 1996 May-Jun;42(3):236-9
references: 8725698
references: Am J Pathol. 1939 May;15(3):353-362.5
references: 19970453
references: Pediatrics. 1991 Nov;88(5):1004-9
references: 1945603
references: J Thorac Cardiovasc Surg. 2007 Oct;134(4):952-959.e2
references: 17903513
references: J Pediatr. 1999 Apr;134(4):428-33
references: 10190916
references: J Pediatr. 1995 Jun;126(6):896-9
references: 7776091
references: J Pediatr Hematol Oncol. 1997 Sep-Oct;19(5):459-61
references: 9329470
references: Blood. 1995 Jul 15;86(2):776-83
references: 7606007
references: Pediatrics. 2008 Apr;121(4):777-82
references: 18381543
references: Blood. 1998 Jan 1;91(1):288-94
references: 9414296
references: Pediatr Crit Care Med. 2011 Mar;12(2):133-6
references: 20453704
references: AJR Am J Roentgenol. 2007 Jun;188(6):1636-42
references: 17515387
references: Respir Care. 2004 Mar;49(3):263-9
references: 14982646
references: N Engl J Med. 1998 Jul 2;339(1):5-11
references: 9647873
references: Blood. 1997 Mar 1;89(5):1787-92
references: 9057664