title: Venoarterial extracorporeal membrane oxygenation support for neonatal and pediatric refractory septic shock.
abstract: OBJECTIVE
  To report our institutional experience of veno-arterial extracorporeal membrane oxygenation (VA ECMO) in children with refractory septic shock.
  
  
  METHODS
  We retrospectively reviewed our ECMO database to identify patients who received VA ECMO for septic shock from January 2004 to June 2013 at our Pediatric Intensive Care Unit in Armand-Trousseau Hospital. We included all neonates and children up to the age of 18 years who received VA ECMO for septic shock. For each patient, we collected the pre-ECMO inotrope score, clinical circulatory and ventilatory parameters, infecting organism, ECMO duration and complications, and length of hospital stay.
  
  
  RESULTS
  The study included 14 neonates and 8 older children (the pediatric population, with a mean age of 30 months, range: 1-113 months). Survival was 64% among newborns and 50% among pediatric patients. Multiorgan failure or severity scores did not show any correlation with mortality (Pediatric Logistic Organ Dysfunction score, P = 0.94; the score for neonatal acute physiology-perinatal extension II, P = 0.34). In the pediatric population, the inotrope score was higher in the survivor group (127.5 vs. 332.5, P = 0.07). Blood samples taken shortly before cannulation showed that pH (P = 0.27), lactate level (P = 0.33), PaO2/FiO2 ratio (P = 0.49), or oxygenation index (P = 0.35) showed no correlation to success or failure of ECMO.
  
  
  CONCLUSIONS
  ECMO can be safely used to resuscitate and support children with refractory septic shock. We recommend that patients with oliguria whose lactate level has not decreased within 6 h of starting maximum drug therapy be transferred to an ECMO referral center.
authors.affiliation: Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Paris, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Rambaud
authors.affiliation: Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Guellec
authors.affiliation: Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Paris, France.
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Léger
authors.affiliation: Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Renolleau
authors.affiliation: Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Paris, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Guilbert
keywords: Extracorporeal membrane oxygenation; neonatal; pediatric; refractory; septic shock