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01-12-2020 | Shock | Letter

ECMO in paediatric septic shock: an urgent need for prospective trial

Authors: Xavier Beretta-Piccoli, Dominique Biarent, David De Bels, Patrick M. Honore, Sébastien Redant

Published in: Critical Care | Issue 1/2020

Excerpt

The publication by Schlapbach et al. used a sepsis mortality prediction model to define a mortality threshold above which patients suffering from septic shock could benefit from venoarterial ECMO (VA-ECMO). When predicted mortality was lower than 47.1%, the measured mortality was 11.8% higher, while when the predicted mortality was higher than 47.1%, the measured mortality was 16.2% lower. Seventy-one per cent of patients were cannulated centrally with a central flow significantly higher than peripheral ECMO (173 versus 129 ml/kg/min, p < 0.05) [1]. However, central techniques are not available everywhere, and percutaneous VA-ECMO technique is spreading and frequently done by intensivists but does not allow flow as high as those described by Schlapbach. We were surprised by the benefit brought by central cannulation on survival in the multivariate analysis (p = 0.046) while higher flows did not reach significance on survival nor in the uni- (p = 0.27) nor in the multivariate analyses (p = NS). Other studies in paediatric septic shock have shown a survival benefit from ECMO flow rates greater than 150 ml/kg/min [2]. …

Schlapbach LJ, Chiletti R, Straney L, Festa M, Alexander D, Butt W, et al. Defining benefit threshold for extracorporeal membrane oxygenation in children with sepsis-a binational multicenter cohort study. Crit Care. 2019;23(1):429. https://doi.org/10.1186/s13054-019-2685-1.CrossRefPubMedPubMedCentral

Oberender F, Ganeshalingham A, Fortenberry JD, Hobson MJ, Houmes RJ, Morris KP, et al. Venoarterial extracorporeal membrane oxygenation versus conventional therapy in severe pediatric septic shock. Pediatr Crit Care Med. 2018;19(10):965–72. https://doi.org/10.1097/PCC.0000000000001660.CrossRef

Aneja RK, Carcillo JA. Differences between adult and pediatric septic shock. Minerva Anestesiol. 2011;77(10):986–92.PubMed

Davis AL, Carcillo JA, Aneja RK, Deymann AJ, Lin JC, Nguyen TC, et al. The American College of Critical Care Medicine clinical practice rarameters for hemodynamic support of pediatric and neonatal septic shock: executive summary. Pediatr Crit Care Med. 2017;18(9):884–90. https://doi.org/10.1097/PCC.0000000000001259.CrossRefPubMed

Abdalaziz FA, Algebaly HAF, Ismail RI, El-Sherbini SA, Behairy A. The use of bedside echocardiography for measuring cardiac index and systemic vascular resistance in pediatric patients with septic shock. Rev Bras Ter Intensiva. 2018;30(4):460–70. https://doi.org/10.5935/0103-507X.20180067.CrossRefPubMedPubMedCentral

Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020;46(Suppl 1):10–67.

Morin L, Ray S, Wilson C, Remy S, Benissa MR, Jansen NJG, Javouhey E, Peters MJ, Kneyber M, De Luca D, et al. Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition. Intensive Care Med. 2016;42(12):1948–57.CrossRef

Schlapbach LJ, MacLaren G, Festa M, Alexander J, Erickson S, Beca J, Slater A, Schibler A, Pilcher D, Millar J, et al. Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Intensive Care Med. 2017;43(8):1085–96.CrossRef

MacLaren G, Cho HJ, Schlapbach LJ. Transforming Data Into a Crystal Ball-Predicting Outcomes After Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med. 2019;20(5):490-91.CrossRef

Title: ECMO in paediatric septic shock: an urgent need for prospective trial
Authors: Xavier Beretta-Piccoli
Dominique Biarent
David De Bels
Patrick M. Honore
Sébastien Redant
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Shock
Septicemia
Septicemia
Shock
Septic Shock
ECMO
ECMO
Published in: Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-020-2789-7

At a glance: The STEP trials

Springer Medicine

ECMO in paediatric septic shock: an urgent need for prospective trial

Excerpt

At a glance: The STEP trials

Springer Medicine

Excerpt

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