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Article: Extracorporeal cardiopulmonary resuscitation in adults and children: A review of literature, published guidelines and pediatric single-center program building experience.

Olson, Taylor / Anders, Marc / Burgman, Cole / Stephens, Adam / Bastero, Patricia

2022 Volume 9, Page(s) 935424

Abstract: Extracorporeal cardiopulmonary resuscitation (ECPR) is an adjunct supportive therapy to conventional cardiopulmonary resuscitation (CCPR) employing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of refractory cardiac arrest. ... ...

Abstract	Extracorporeal cardiopulmonary resuscitation (ECPR) is an adjunct supportive therapy to conventional cardiopulmonary resuscitation (CCPR) employing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of refractory cardiac arrest. Its use has seen a significant increase in the past decade, providing hope for good functional recovery to patients with cardiac arrest refractory to conventional resuscitation maneuvers. This review paper aims to summarize key findings from the ECPR literature available to date as well as the recommendations for ECPR set forth by leading national and international resuscitation societies. Additionally, we describe the successful pediatric ECPR program at Texas Children's Hospital, highlighting the logistical, technical and educational features of the program.
Language	English
Publishing date	2022-11-21
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2022.935424
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Article: Comparison of Platelet Mass Index to Platelet Count as Transfusion Trigger in Neonatal Extracorporeal Membrane Oxygenation.

Hui, Shiu-Ki R / Cuestas, Jenifer / Hagan, Joseph L / Anders, Marc M / Fernandes, Caraciolo J

Clinical laboratory

2023 Volume 69, Issue 7

Abstract: Background: Platelet transfusions are routinely administered to neonates in intensive care units when there are concerns of bleeding, including high-risk situations like Extracorporeal Membrane Oxygenation (ECMO). Most platelets in ICUs are transfused ... ...

Abstract	Background: Platelet transfusions are routinely administered to neonates in intensive care units when there are concerns of bleeding, including high-risk situations like Extracorporeal Membrane Oxygenation (ECMO). Most platelets in ICUs are transfused prophylactically for thrombocytopenia based solely on the platelet count. Platelet Mass Index (PMI) has been proposed as an alternative to platelet count (PC) as a transfusion trigger. The objective of this study was to determine the relationship between PMI and platelet-specific maximal clot firmness (PMCF) in Rotational thromboelastometry (ROTEM), which gives an indication of platelet contribution to clot firmness and to investigate whether PMI may be a better choice as a trigger for platelet transfusions than PC. Methods: Retrospective review of medical records of neonates with congenital heart disease placed on ECMO support in the cardiovascular intensive care unit (CVICU) from 2015 to 2018 was conducted. Platelet count (PC), platelet mean volume (PMV), ROTEM parameters along with demographic data including gestation age, birth weight, gender and survival were collected. Mixed effects linear models with a first order autoregressive covariance structure were used to assess the associations of PMI, PC, and MPV against PMCF. In addition, generalized estimating equations with a first order auto-regressive covariance structure were used to compare odds of transfusion using PC versus PMI triggers. Results: A total of 92 tests on consecutive days were obtained for 12 ECMO patients (5 male, GA = 38.1 ± 1.6 weeks, BW = 3.1 ± 0.4 kgs, mean ± SD). A variation of 40.1% in PMCF was explained by platelet count (p < 0.001) while 38.5% of the variation in PMCF was explained by PMI (p < 0.001). If the platelet transfusion trigger was PC < 100 x 103 platelets/µL vs. PMI < 800. Using the PC trigger yielded significantly higher odds of transfusion compared to the PMI trigger (odds ratio = 1.31, 95% confidence interval: 1.18 - 1.45, p < 0.001). Conclusions: While our study failed to demonstrate a superior correlation of PMI with PMCF than PC, our study did reveal that using PMI as transfusion trigger would result in significantly less platelet transfusions, when compared with the current practice of using PC as a trigger.
MeSH term(s)	Infant, Newborn ; Humans ; Male ; Platelet Count ; Extracorporeal Membrane Oxygenation/adverse effects ; Thrombocytopenia/therapy ; Blood Transfusion ; Blood Platelets ; Platelet Transfusion/adverse effects
Language	English
Publishing date	2023-07-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1307629-2
ISSN	1433-6510 ; 0941-2131
ISSN	1433-6510 ; 0941-2131
DOI	10.7754/Clin.Lab.2022.221202
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Article ; Online: Cardiac Tamponade Complicating Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis.

Basílio, Carla / Anders, Marc / Rycus, Peter / Paiva, José Artur / Roncon-Albuquerque, Roberto

Journal of cardiothoracic and vascular anesthesia

2023 Volume 38, Issue 3, Page(s) 731–738

Abstract: Objectives: Cardiac tamponade is a potentially life-threatening complication during extracorporeal membrane oxygenation (ECMO). In this study, the authors assessed the incidence, patient characteristics, and risk factors for mortality of cardiac ... ...

Abstract	Objectives: Cardiac tamponade is a potentially life-threatening complication during extracorporeal membrane oxygenation (ECMO). In this study, the authors assessed the incidence, patient characteristics, and risk factors for mortality of cardiac tamponade during ECMO. Design: The authors queried the Extracorporeal Life Support Organization (ELSO) Registry from 1997 to 2021 for all adults with cardiac tamponade as a reported complication during ECMO. Participants: Cardiac tamponade was reported in 2,176 (64% men; 53.8 ± 0.33 years) of 84,430 adults (2.6%). Measurements and main results: Venoarterial ECMO was the main configuration (78%), followed by venovenous ECMO (VV ECMO) (18%), for cardiac (67%), pulmonary (21%) support, and extracorporeal cardiopulmonary resuscitation (ECPR) (12%). Percutaneous cannulation was performed in 51%, with the femoral vein and femoral artery as the most common sites for drainage and return cannulae, with dual-lumen cannulae in 39% of VV ECMO. Hospital survival was lower (35% v 49%; p < 0.01) when compared with that of all adults from the ELSO Registry. In multivariate analysis, age, aortic dissection and/or rupture, COVID-19, ECPR, pre-ECMO renal-replacement therapy, and prone position are associated with hospital mortality, whereas ECMO for pulmonary support is associated with hospital survival. Similarly, renal, cardiovascular, metabolic, neurologic, and pulmonary complications occurred more frequently in nonsurvivors. Conclusions: Cardiac tamponade is a rare complication during ECMO that, despite being potentially reversible, is associated with high hospital mortality. Venoarterial ECMO is the most common configuration. ECMO for pulmonary support was associated with higher survival, and ECPR was associated with higher mortality. In these patients, other ECMO-related complications were frequently reported and associated with hospital mortality.
MeSH term(s)	Male ; Adult ; Humans ; Female ; Extracorporeal Membrane Oxygenation/adverse effects ; Cardiac Tamponade/epidemiology ; Cardiac Tamponade/etiology ; Cardiopulmonary Resuscitation ; Risk Factors ; Registries ; Retrospective Studies
Language	English
Publishing date	2023-12-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2023.12.027
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Article: The Neglected Variable.

Anders, Marc / Bronicki, Ronald A

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2017 Volume 18, Issue 3, Page(s) 282–283

MeSH term(s)	Arteries ; Carbon Dioxide ; Cardiac Surgical Procedures ; Child Abuse ; Veins
Chemical Substances	Carbon Dioxide (142M471B3J)
Language	English
Publishing date	2017-03-03
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000001101
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Article ; Online: Improving Outcomes for Children Requiring Extracorporeal Membrane Oxygenation Therapy Following Hematopoietic Stem Cell Transplantation.

Olson, Taylor L / O'Neil, Erika R / Kurtz, Kristen J / MacLaren, Graeme / Anders, Marc M

Critical care medicine

2021 Volume 49, Issue 4, Page(s) e381–e393

Abstract: Objectives: The objective of this study was to provide an updated review of survival for pediatric hematopoietic stem cell transplantation patients requiring extracorporeal membrane oxygenation therapy as well as characterize the demographics, clinical ... ...

Abstract	Objectives: The objective of this study was to provide an updated review of survival for pediatric hematopoietic stem cell transplantation patients requiring extracorporeal membrane oxygenation therapy as well as characterize the demographics, clinical variables, and complications associated with mortality. Design: Retrospective database review of the Extracorporeal Life Support Organization Registry from 1990 to 2019. Setting: Extracorporeal membrane oxygenation centers reporting to Extracorporeal Life Support Organization. Patients: Patients treated with extracorporeal membrane oxygenation greater than 28 days to 18 years old with International Classification of Diseases Ninth Revision, International Classification of Diseases Tenth Revision, and current procedural terminology codes consistent with hematopoietic stem cell transplantation were included. Interventions: None. Measurements and main results: Demographics, year of extracorporeal membrane oxygenation run, clinical variables, comorbid diagnoses, and extracorporeal membrane oxygenation complications were assessed in relation to the primary study outcome of survival to hospital discharge. Ninety patients were included in the final analysis. The overall survival rate for the study period was 19%. However, the survival rate in the last decade (2010-2019) improved to 26% (p = 0.01; odds ratio 9.4 [1.2-74.8]). Factors associated with decreased survival included comorbid malignancy, elevated peak inspiratory pressure in conventionally ventilated patients, and pulmonary and metabolic complications on extracorporeal membrane oxygenation. Conclusions: Pediatric patients posthematopoietic stem cell transplantation supported with extracorporeal membrane oxygenation have improving survival rates over time. With 26% of patients (16/62) surviving to hospital discharge in the last decade (2010-2019), history of hematopoietic stem cell transplantation may no longer be considered an absolute contraindication to extracorporeal membrane oxygenation. As advancements are made in hematopoietic stem cell transplantation therapies and extracorporeal membrane oxygenation management, the indications for life-saving extracorporeal membrane oxygenation support among patients posthematopoietic stem cell transplantation may expand accordingly.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Critical Illness/mortality ; Critical Illness/therapy ; Extracorporeal Membrane Oxygenation/adverse effects ; Extracorporeal Membrane Oxygenation/mortality ; Female ; Hematopoietic Stem Cell Transplantation/mortality ; Humans ; Infant ; Male ; Respiratory Insufficiency/mortality ; Respiratory Insufficiency/therapy ; Risk Factors ; Survival Rate
Language	English
Publishing date	2021-01-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000004850
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Article ; Online: Epidemiology of Pediatric Heart Failure in the USA-a 15-Year Multi-Institutional Study.

Morales-Demori, Raysa / Montañes, Elena / Erkonen, Gwen / Chance, Michael / Anders, Marc / Denfield, Susan

Pediatric cardiology

2021 Volume 42, Issue 6, Page(s) 1297–1307

Abstract: The epidemiology of pediatric heart failure (HF) has been characterized for congenital heart disease (CHD) and cardiomyopathies (CM), but the impact of CM associated with CHD has not been studied. This study aims to describe the characteristics and ... ...

Abstract	The epidemiology of pediatric heart failure (HF) has been characterized for congenital heart disease (CHD) and cardiomyopathies (CM), but the impact of CM associated with CHD has not been studied. This study aims to describe the characteristics and outcomes of inpatient pediatric HF patients with CHD, CM, and CHD with CM (CHD + CM) across the USA. We included all HF patients with CM diagnoses with and without CHD using ICD 9/10 codes ≤ 19 years old from January 2004 to September 2019 using the Pediatric Health Information System database. We identified 67,349 unique patients ≤ 19 years old with HF, of which 87% had CHD, 7% had CHD + CM, and 6% had CM. Pediatric HF admissions increased significantly from 2004 to 2018 with an associated increase in extracorporeal circulatory support (ECLS) use. Heart transplantation (HTX) increased only in the CHD and CHD + CM groups. CHD patients required less ECLS with and without HTX; however, they had significantly higher inpatient mortality after those procedures than the other groups (p < 0.001). CM patients were older (median 115 months) and had the lowest inpatient mortality after HTX with and without ECLS (p < 0.05). CHD + CM showed the highest overall inpatient mortality (15%), and cumulative hospital billed charges (median US$ 541,374), all p < 0.001. Pediatric HF admissions have increased from 2004 to 2018. ECLS use and HTX have expanded in this population, with an associated decrease in inpatient mortality in the CHD and CM groups. CHD + CM patients are a growing population with the highest inpatient mortality.
MeSH term(s)	Child ; Child, Preschool ; Female ; Heart Failure/epidemiology ; Humans ; Infant ; Infant, Newborn ; Male ; United States/epidemiology
Language	English
Publishing date	2021-04-19
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	800857-7
ISSN	1432-1971 ; 0172-0643
ISSN (online)	1432-1971
ISSN	0172-0643
DOI	10.1007/s00246-021-02611-3
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Article ; Online: In-hospital Morbidity and Mortality After Modified Blalock-Taussig-Thomas Shunts.

Headrick, Andrew T / Qureshi, Athar M / Ghanayem, Nancy S / Heinle, Jeffrey / Anders, Marc

The Annals of thoracic surgery

2021 Volume 114, Issue 1, Page(s) 168–175

Abstract: Background: The modified Blalock-Taussig-Thomas shunt is a critically important palliation for patients with insufficient pulmonary blood flow associated with congenital heart disease. After creating a modified Blalock-Taussig-Thomas shunt patients ... ...

Abstract	Background: The modified Blalock-Taussig-Thomas shunt is a critically important palliation for patients with insufficient pulmonary blood flow associated with congenital heart disease. After creating a modified Blalock-Taussig-Thomas shunt patients experience high rates of early postoperative morbidity and mortality. Methods: This is a single-institution retrospective cohort study. A query of The Society of Thoracic Surgeons database identified relevant patients whose health records were manually queried for echocardiography and operative reports. Patients with ductal-dependent systemic circulation were excluded. Primary outcomes were early serious adverse events and in-hospital mortality. Secondary outcomes were time to primary outcomes and postoperative lengths of stay. We investigated the correlation of demographics, presence of competitive pulmonary blood flow, and surgical and anatomic factors on outcomes. Results: After exclusions our cohort comprised 155 patients. Thirty-three patients (21.3%) experienced an early serious adverse event, 10 (6.5%) early shunt malfunction, and 11 (7.1%) in-hospital mortality. Smaller shunt size, smaller shunted pulmonary artery size, surgical approach, and site of proximal shunt anastomosis were independently associated with morbidity and mortality. Conclusions: Anatomic elements imparting increased resistance along the modified Blalock-Taussig-Thomas shunt predispose to increased morbidity and mortality, particularly in the early postoperative period. Despite the significant heterogeneity of patients receiving such shunts, similar risk profiles are observed regardless of lesion or presence of competitive flow. A surgical approach using thoracotomy with shunt anastomosis to the subclavian artery, where feasible, results in the subclavian artery as the point of natural resistance, allowing for placement of larger shunts and yielding lower morbidity and mortality.
MeSH term(s)	Blalock-Taussig Procedure/adverse effects ; Heart Defects, Congenital ; Hospitals ; Humans ; Morbidity ; Pulmonary Artery/surgery ; Pulmonary Circulation ; Retrospective Studies
Language	English
Publishing date	2021-11-24
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2021.11.003
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Article: Vasoplegic Shock Represents a Dominant Hemodynamic Profile of Multisystem Inflammatory Syndrome Following COVID-19 in Children and Adolescents.

Alali, Alexander / O'Neil, Erika / Anders, Marc / Abella, Jayvee / Shekerdemian, Lara S / Vogel, Tiphanie P / Sexson Tejtel, Kristen / Tume, Sebastian C

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2022 Volume 23, Issue 6, Page(s) e295–e299

Abstract: Objectives: The hemodynamic profile of multisystem inflammatory syndrome in children (MIS-C)-related shock remains poorly defined and, therefore, challenging to support with pharmacotherapy in the ICU. We aimed to evaluate the hemodynamic profile and ... ...

Abstract	Objectives: The hemodynamic profile of multisystem inflammatory syndrome in children (MIS-C)-related shock remains poorly defined and, therefore, challenging to support with pharmacotherapy in the ICU. We aimed to evaluate the hemodynamic profile and vasoactive medication management used in MIS-C patients presenting to the ICU in shock and provide data from high-fidelity continuous cardiac output monitoring. Design: Single-center retrospective case-cohort study. Setting: Pediatric and cardiac ICU in a quaternary-care hospital. Patients: All patients who met U.S. Centers for Disease Control and Prevention criteria for MIS-C and who were admitted to the ICU between March 2020 and May 2021 required vasoactive support and were placed on continuous cardiac index (CCI) monitoring. Patients requiring extracorporeal life support were excluded. Interventions: None. Measurements and main results: Among 52 children with MIS-C presenting in shock and requiring vasoactive support, 14 patients (27%) were placed on CCI monitoring. These 14 patients had hyperdynamic cardiac index (CI) and low indexed systemic vascular resistance (SVRi) in the first 24 hours with normalization of CI and improved SVRi within the subsequent 24 hours. Conclusions: Further studies are needed to evaluate the difference between the use of vasoconstrictor versus vasodilators in pediatric patients with MIS-C because a phenotype with high CI and low SVRi may be important.
MeSH term(s)	Adolescent ; COVID-19/complications ; Child ; Cohort Studies ; Hemodynamics ; Humans ; Retrospective Studies ; Shock/etiology ; Systemic Inflammatory Response Syndrome
Language	English
Publishing date	2022-03-31
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000002954
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Article ; Online: Extracorporeal Membrane Oxygenation Support for Interstitial Lung Disease in Idiopathic Inflammatory Myopathies: An ELSO Registry Analysis.

Quinn, Rachel E / Riedl, Ruth / Rycus, Peter T / Vogel, Tiphanie P / Silva-Carmona, Manuel / Anders, Marc M / O'Neil, Erika R

ASAIO journal (American Society for Artificial Internal Organs : 1992)

2022 Volume 69, Issue 2, Page(s) e96–e99

MeSH term(s)	Humans ; Extracorporeal Membrane Oxygenation ; Retrospective Studies ; Registries ; Lung Diseases, Interstitial/therapy ; Myositis/therapy
Language	English
Publishing date	2022-10-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	759982-1
ISSN	1538-943X ; 0162-1432 ; 1058-2916
ISSN (online)	1538-943X
ISSN	0162-1432 ; 1058-2916
DOI	10.1097/MAT.0000000000001798
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Article ; Online: Cardiovascular sequelae from COVID-19: perspectives from a paediatric cardiac ICU.

Lasa, Javier J / Alali, Alexander / Anders, Marc / Tume, Sebastian C / Muscal, Eyal / Tejtel, S Kristen Sexson / Shekerdemian, Lara

Cardiology in the young

2022 , Page(s) 1–8

Abstract: Objective: Paediatric ICUs have shared the burden of the COVID-19 pandemic, including subspecialty cardiac ICUs. We sought to address knowledge gaps regarding patient characteristics, acuity, and sequelae of COVID-19 in the paediatric cardiac ICU ... ...

Abstract	Objective: Paediatric ICUs have shared the burden of the COVID-19 pandemic, including subspecialty cardiac ICUs. We sought to address knowledge gaps regarding patient characteristics, acuity, and sequelae of COVID-19 in the paediatric cardiac ICU setting. Design: Retrospective review of paediatric cardiac ICU admissions with COVID-19-related disease. Setting: Single centre tertiary care paediatric cardiac ICU. Patients: All patients with PCR/antibody evidence of primary COVID-19 infection, and/or Multisystem Inflammatory Syndrome in Children, were admitted between 26 March, 2020 and 31 March, 2021. Interventions: None. Main outcomes measures: Patient-level demographics, pre-existing conditions, clinical symptoms, and outcomes related to ICU admission were captured from medical records. Results: Among 1064 patients hospitalised with COVID-19/Multisystem Inflammatory Syndrome in Children, 102 patients (9.5%) were admitted to cardiac ICU, 76 of which were symptomatic (median age 12.5 years [IQR 7.5-16.0]). The primary system involved at presentation was cardiovascular in 48 (63%). Vasoactive infusions were required in 62% (n = 47), with eight patients (11%) requiring VA ECMO. Severity of disease was categorised as mild/moderate in 16 (21%) and severe/critical in 60 patients (79%). On univariate analysis, African-American race, presentation with gastrointestinal symptoms or elevated inflammatory markers were associated with risk for severe disease. All-cause death was observed in five patients (7%, n = 5/72) with four patients remaining hospitalised at the time of data query. Conclusion: COVID-19 and its cardiovascular sequelae were associated with important morbidity and significant mortality in a notable minority of paediatric patients admitted to a paediatric cardiac ICU. Further study is required to quantify the risk of morbidity and mortality for COVID-19 and sequelae.
Language	English
Publishing date	2022-02-24
Publishing country	England
Document type	Journal Article
ZDB-ID	1078466-4
ISSN	1467-1107 ; 1047-9511
ISSN (online)	1467-1107
ISSN	1047-9511
DOI	10.1017/S1047951122000130
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