title: "Awake Veno-arterial Extracorporeal Membrane Oxygenation" in Pediatric Cardiogenic Shock: A Single-Center Experience.
abstract: In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients. We therefore present data of six of our patients with CS, who were treated by ECMO being awake without continuous analgosedation and invasive ventilation. Of these six patients, four were <1 year and two >14 years of age. Median time on ECMO was 17.4 days (range 6.9-94.2 days). Median time extubated, while receiving ECMO support was 9.5 days. Mean time extubated was 78 % of the total time on ECMO. Three patients reached full recovery of cardiac function on "Awake-VA-ECMO," whereas the other three were successfully bridged to destination therapy (VAD, heart transplantation, withdrawal). Four out of our six patients are still alive. Complications related to ECMO therapy (i.e., severe bleeding, site infection or dislocation of cannulas) were not observed. We conclude that "Awake-VA-ECMO" in extubated, spontaneously breathing conscious pediatric patients is feasible and safe for the treatment of acute CS and can be used as a "bridging therapy" to recovery, VAD implantation or transplantation.
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. schmidt.florian@mh-hannover.de.
authors.forename: F
authors.initials: F
authors.lastname: Schmidt
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Jack
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Sasse
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kaussen
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Bertram
authors.affiliation: Department of Cardiothoracic Surgery, Transplantation and Vascular Surgery, Medical School Hannover, Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Horke
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Seidemann
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Beerbaum
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Koeditz
mesh_terms: D000293:Adolescent; D060666:Airway Extubation; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute cardiac failure; Awake pediatric extracorporeal life support; Cardiogenic shock; Extracorporeal membrane oxygenation; Extubation