Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces mor...Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.展开更多
Background To summarize the experience of management of persistent pulmonary hypertension of the newborn (PPHN) with extracorporeal membrane oxygenation (ECMO) support.Methods We presented three neonates with PPHN sup...Background To summarize the experience of management of persistent pulmonary hypertension of the newborn (PPHN) with extracorporeal membrane oxygenation (ECMO) support.Methods We presented three neonates with PPHN supported by ECMO in our center.Medical records and patient management notes were retrospectively reviewed.Results For two neonates with congenital diaphragmatic hernia (CDH),diaphragm repair surgery was done under ECMO support.One patient was weaned from ECMO after 73 hours,and recovered well at the last follow-up after 1 year.The other patient was weaned from ECMO after 167 hours,and he died from septic shock 21 days after decannulation.For the neonate with idiopathic PPHN,ECMO was withdrawn successfully.Conclusions ECMO is an effective rescue means for refractory PPHN.Appropriate intervention timing,accurate coagulation,and volume management are important.展开更多
基金This study was supported by“the Fundamental Research Funds for the Central Universities”(No.226-2022-00060)National Key R&D Program of China(No.2021YFC2701700).
文摘Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.
文摘Background To summarize the experience of management of persistent pulmonary hypertension of the newborn (PPHN) with extracorporeal membrane oxygenation (ECMO) support.Methods We presented three neonates with PPHN supported by ECMO in our center.Medical records and patient management notes were retrospectively reviewed.Results For two neonates with congenital diaphragmatic hernia (CDH),diaphragm repair surgery was done under ECMO support.One patient was weaned from ECMO after 73 hours,and recovered well at the last follow-up after 1 year.The other patient was weaned from ECMO after 167 hours,and he died from septic shock 21 days after decannulation.For the neonate with idiopathic PPHN,ECMO was withdrawn successfully.Conclusions ECMO is an effective rescue means for refractory PPHN.Appropriate intervention timing,accurate coagulation,and volume management are important.
