1 / 23

Pediatricke ECMO (pro koho, kdy a jak)

Pediatricke ECMO (pro koho, kdy a jak). Ann Karimova Great Ormond Street Hospital for Children, London. pediatricke ECMO - pro koho, kdy a jak. Novorozenecke ECMO respiracni (MAS, CDH, PPHN). PediatrickeECMO (respiracni). Kardiologicke “ECMO” (kardiochirurgicke myokarditidy

caril
Download Presentation

Pediatricke ECMO (pro koho, kdy a jak)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pediatricke ECMO (pro koho, kdy a jak) Ann Karimova Great Ormond Street Hospital for Children, London

  2. pediatricke ECMO - pro koho, kdy a jak Novorozenecke ECMO respiracni (MAS, CDH, PPHN) PediatrickeECMO (respiracni) Kardiologicke “ECMO” (kardiochirurgicke myokarditidy kardiomyopatie arytmie…)

  3. pediatricke ECMO - pro koho, kdy a jak Novorozenecke ECMO respiracni (MAS, CDH, PPHN) PediatrickeECMO (respiracni)

  4. pediatricke ECMO - pro koho, kdy a jak PediatrickeECMO (respiracni)

  5. pediatricke ECMO - pro koho, kdy a jak PediatrickeECMO (respiracni)

  6. 600-800/ year (decreasing) 200-250/ year

  7. pediatricke ECMO - pro koho a kdy • Indications: • • severe AHRF refractory to conventional treatment (???) (?how severe is severe enough? - patient likely to die) • reversible cause of respiratory failure. • less than (7) 10 (14) days invasive ventilation (???) ??? inclusion exclusion criteria for pediatric ECMO ??? inclusion exclusion criteria for pediatric ECMO BMC Health Serv Res. 2006

  8. pediatricke ECMO - pro koho a kdy Exclusion criteria • irreversible lung pathology such as fibrosis, pulmonary hypertension,… (???) • contraindication to heparinisation (low patelets !!!) • evidence of severe neurological injury • established multi-organ dysfunction of 4 or more organs ??? not so easy to evaluate on admisssion !!!

  9. pediatricke ECMO - pro koho a kdy Exclusion criteria – cont. • ??? approach to co-morbidity (pre-existing co-morbid condition is acceptable if treatable and compatible with good quality of life) • prolonged cardiac arrest (? how long is too long? 20 to 40 mins?) ECMO as “ECPR” …ECMO rescued 1/3 of patients in whom death was otherwise certain…

  10. ECMO as “ECPR” ECMO as “ECPR” pediatricke ECMO - pro koho a kdy

  11. pediatricke ECMO - jak overal survival in pediatric ECMO is 50-60%

  12. pediatricke ECMO - pro koho, kdy a jak United Kingdom population 60 million 4 ECMO centers total ECMO around 200 runs/ year Great Ormond Street Hospital Cardio-thoracic and ECMO unit • 500-600 admission per year • around 40-50 ECMO runs per year

  13. pediatricke ECMO - pro koho, kdy a jak Retrospective review of all paediatric ECMO cases ( age 28 days to 18 years) at Great Ormond Street Hospital for Children between 1992 – 2005 (primary cardiac patients excluded) •total 124paediatric respiratory ECMO cases were supported (range 7-15 cases per year) • median age was 10.1 months and a median weight of 8kg • median number of pre-ECMO ventilation days was 2 •median worst pre-ECMO OI was 39.1 •median duration of ECMO support was 9 days 2008 Brown et al.: GOSH ECMO data

  14. pediatricke ECMO - pro koho, kdy a jak overall 1 year survival 59% viral infections 58 patients, survival 66% pertussis 9 patients, survival 55% bacterial pneumonia 14 patients, survival 52% sepsis/ septic shock 17 patients,survival 53% aspiration 3 patients,all survived hemo-oncol 2(+1) patients, all died 1 year survival in % 2008 Brown et al.: GOSH ECMO data

  15. pediatricke ECMO - jak VA 63% of patients (46% mortality), VV 27% (24% mortality) conversion VV to VA 10% (50% mortality). GOSH VV versus VA ELSO registry data 2008 Brown et al.: GOSH ECMO data

  16. pediatricke ECMO - jak

  17. pediatricke ECMO - pro koho, kdy a jak RISK FACTORS for DEATH 1.septic shock(P=0.01) 2.oxygenation index(P=0.05) 3.pre-ECMO ventilation (P=0.08) 4.end-organ dysfunction (P=0.09) For each 5 points increment in OI the risk of death increased by 9% Pre-ECMO OI 2008 Brown et al.: GOSH ECMO data

  18. pediatricke ECMO - pro koho, kdy a jak …pre-existing co-morbidities may predispose children to develop severe AHRF but do not reduce survival 53% children had pre-existing co-morbidity 2008 Brown et al.: GOSH ECMO data

  19. pediatricke ECMO - pro koho, kdy a jak CONCLUSIONS: … ECMO should be considered promptly in the deteriorating child who does not respond to conventional treatment… 2008 Brown et al.: GOSH ECMO data

  20. pediatricke ECMO - pro koho, kdy a jak CONCLUSIONS: … ECMO should be considered promptly in the deteriorating child who does not respond to conventional treatment… total ECMO cost around £10 000 per day 2008 Brown et al.: GOSH ECMO data

  21. pediatricke ECMO - pro koho, kdy a jak long term follow up: • CONCLUSIONS: ECLS is a complex therapy which has been used in Australian children for 18 years; a third of children survived long term, and 96% of these had a favourable outcome

  22. pediatricke ECMO - pro koho, kdy a jak long term follow up: total ECMO cost around £10 000 per day • CONCLUSIONS: ECLS is a complex therapy which has been used in Australian children for 18 years; a third of children survived long term, and 96% of these had a favourable outcome

More Related