Is there a role for extracorporeal membrane oxygenation in children with acute liver failure? A retrospective analysis of the Extracorporeal Life Support Organization Registry.

IF 3 3区医学 Q1 PEDIATRICS European Journal of Pediatrics Pub Date : 2024-11-01 Epub Date: 2024-09-25 DOI:10.1007/s00431-024-05794-y

Matteo Di Nardo, Raphael Joye, Danilo Alunni-Fegatelli, Vladimir L Cousin, Ravi R Thiagarajan, Serge Grazioli, Peter Rycus, Angelo Polito

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Abstract

Data describing the use of extracorporeal membrane oxygenation (ECMO) in pediatric acute liver failure (PALF) are scarce. Thus, we aimed to describe the use of ECMO in patients with PALF using the data from the Extracorporeal Life Support Organization (ELSO) Registry between January 1, 2010, to December 31, 2022. We described patients' characteristics at ECMO initiation, outcome, and factors associated with mortality. A total of 335 children underwent ECMO support in the context of PALF. Veno-arterial (VA) ECMO was the most prevalent mode (66.6%), followed by veno-venous (VV) ECMO (33.4%). Extracorporeal cardiopulmonary resuscitation (ECPR) was used in 21.5% of the cardiac arrest. In-hospital mortality was 66.6%. Both higher lactate (OR 1.128, CI 1.06-1.209, p < 0.001) and PaCO₂ (OR 1.022, CI 1.001-1.047, p 0.05) levels before ECMO reported greater odds of mortality. Low body weight, persistence of hyperlactatemia (OR 0.985, CI 0.973-0.997, p 0.013), and hyperbilirubinemia (OR 2.477, CI 1.042-6.100, p 0.045) after 24 h from ECMO deployment were associated to greater odds of mortality.

Conclusions: Our results suggest that the use of ECMO for the management of respiratory and cardiac failure in patients with PALF should be considered with caution and that further research is needed to understand its role in this specific high-risk population.

What is known: • Pediatric acute liver failure (PALF) is a clinical syndrome associated with significant morbidity and mortality. • Data on the use of extracorporeal membrane oxygenation (ECMO) in the context of PALF are scarce and controversial.

What is new: • ECMO to manage acute respiratory and/or cardiac failure in the context of PALF should be considered with caution. • Bleeding and thrombotic complications in children with acute liver failure receiving ECMO are similar to the ones reported in the general pediatric population.

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体外膜肺氧合在急性肝衰竭患儿中的作用？体外生命支持组织登记处的回顾性分析。

描述体外膜肺氧合（ECMO）用于小儿急性肝衰竭（PALF）的数据很少。因此，我们旨在利用体外生命支持组织（ELSO）登记处 2010 年 1 月 1 日至 2022 年 12 月 31 日期间的数据，描述 ECMO 在 PALF 患者中的应用情况。我们描述了患者开始接受 ECMO 时的特征、结果以及与死亡率相关的因素。共有 335 名 PALF 患儿接受了 ECMO 支持。静脉-动脉 (VA) ECMO 是最普遍的模式（66.6%），其次是静脉-静脉 (VV) ECMO（33.4%）。21.5%的心跳骤停患者使用了体外心肺复苏（ECPR）。院内死亡率为 66.6%。ECMO 前乳酸水平较高（OR 1.128，CI 1.06-1.209，P < 0.001）和 PaCO2 水平较高（OR 1.022，CI 1.001-1.047，P 0.05）的患者死亡率较高。低体重、持续高乳酸血症（OR 0.985，CI 0.973-0.997，P 0.013）和高胆红素血症（OR 2.477，CI 1.042-6.100，P 0.045）与 ECMO 部署 24 小时后更高的死亡几率相关：我们的研究结果表明，应慎重考虑使用 ECMO 治疗 PALF 患者的呼吸和心力衰竭，还需要进一步研究以了解 ECMO 在这一特殊高危人群中的作用：- 已知信息：小儿急性肝衰竭（PALF）是一种与严重发病率和死亡率相关的临床综合征。- 在小儿急性肝衰竭中使用体外膜肺氧合（ECMO）的数据很少，且存在争议：- 新内容：应慎重考虑使用 ECMO 治疗 PALF 中的急性呼吸衰竭和/或心力衰竭。- 接受 ECMO 的急性肝衰竭患儿的出血和血栓形成并发症与普通儿科患儿相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pediatrics 医学-小儿科

CiteScore

5.90

自引率

2.80%

发文量

367

审稿时长

3-6 weeks

期刊介绍： The European Journal of Pediatrics (EJPE) is a leading peer-reviewed medical journal which covers the entire field of pediatrics. The editors encourage authors to submit original articles, reviews, short communications, and correspondence on all relevant themes and topics. EJPE is particularly committed to the publication of articles on important new clinical research that will have an immediate impact on clinical pediatric practice. The editorial office very much welcomes ideas for publications, whether individual articles or article series, that fit this goal and is always willing to address inquiries from authors regarding potential submissions. Invited review articles on clinical pediatrics that provide comprehensive coverage of a subject of importance are also regularly commissioned. The short publication time reflects both the commitment of the editors and publishers and their passion for new developments in the field of pediatrics. EJPE is active on social media (@EurJPediatrics) and we invite you to participate. EJPE is the official journal of the European Academy of Paediatrics (EAP) and publishes guidelines and statements in cooperation with the EAP.