Is there a role for extracorporeal membrane oxygenation in children with acute liver failure? A retrospective analysis of the Extracorporeal Life Support Organization Registry.
ECLS
ECMO
Hyperbilirubinemia
Hyperlactatemia
Pediatric liver dysfunction
Pediatric liver failure
Journal
European journal of pediatrics
ISSN: 1432-1076
Titre abrégé: Eur J Pediatr
Pays: Germany
ID NLM: 7603873
Informations de publication
Date de publication:
25 Sep 2024
25 Sep 2024
Historique:
received:
15
07
2024
accepted:
20
09
2024
revised:
16
09
2024
medline:
26
9
2024
pubmed:
26
9
2024
entrez:
25
9
2024
Statut:
aheadofprint
Résumé
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 PaCO 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. • 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. • 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.
Identifiants
pubmed: 39322851
doi: 10.1007/s00431-024-05794-y
pii: 10.1007/s00431-024-05794-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Deep A, Alexander EC, Bulut Y, Fitzpatrick E, Grazioli S, Heaton N, Dhawan A (2022) Advances in medical management of acute liver failure in children: promoting native liver survival. Lancet Child Adolesc Health 6:725–737
doi: 10.1016/S2352-4642(22)00190-0
pubmed: 35931098
Squires JE, Alonso EM, Ibrahim SH, Kasper V, Kehar M, Martinez M, Squires RH (2022) North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper on the diagnosis and management of pediatric acute liver failure. J Pediatr Gastroenterol Nutr 74:138–158
doi: 10.1097/MPG.0000000000003268
pubmed: 34347674
Ascher Bartlett JM, Yanni G, Kwon Y, Emamaullee J (2022) Pediatric acute liver failure: reexamining key clinical features, current management, and research prospects. Liver Transpl 28:1776–1784
doi: 10.1002/lt.26500
pubmed: 35557028
pmcid: 9588650
Zellos A, Debray D, Indolfi G, Czubkowski P, Samyn M, Hadzic N, Gupte G, Fischler B, Smets F, de Clety SC, Grenda R, Mozer Y, Mancell S, Jahnel J, Auzinger G, Worth A, Lisman T, Staufner C, Baumann U, Dhawan A, Alonso E, Squires RH, Verkade HJ (2022) Proceedings of ESPGHAN Monothematic Conference 2020: “acute liver failure in children”: diagnosis and initial management. J Pediatr Gastroenterol Nutr 74:e45–e56
pubmed: 35226643
Nandhabalan P, Loveridge R, Patel S, Willars C, Best T, Vercueil A, Vilca-Melendez H, Deep A, Heaton N, Auzinger G (2016) Extracorporeal membrane oxygenation and pediatric liver transplantation, “a step too far? ”: results of a single-center experience. Liver Transpl 22:1727–1733
doi: 10.1002/lt.24626
pubmed: 27600579
Son SK, Oh SH, Kim KM, Lee YJ, Jhang WK, Park SJ, Shin HJ, Park JJ, Kim TH, Kim DY, Hwang S, Park KM, Lee YJ, Lee SG (2012) Successful liver transplantation following veno-arterial extracorporeal membrane oxygenation in a child with fulminant Wilson disease and severe pulmonary hemorrhage: a case report. Pediatr Transplant 16:E281-285
doi: 10.1111/j.1399-3046.2011.01604.x
pubmed: 22093921
Mohan N, Singhal N, Stormon MO, Britton PN, Liava’a M, Moynihan KM (2022) Life-threatening acute liver failure and myocarditis needing extracorporeal membrane oxygenation: could it be therapeutic misadventure with paracetamol? J Paediatr Child Health 58:1475–1478
doi: 10.1111/jpc.15865
pubmed: 34962320
Hogen R, Sedra AH, Motamed A, Emamaullee J (2021) The evolving role of ECMO in liver transplantation. Curr Opin Organ Transplant 26:333–338
doi: 10.1097/MOT.0000000000000874
pubmed: 33782248
pmcid: 8269746
Hogen R, Motamed A, Baker C, Genyk Y, Emamaullee J (2021) Intraoperative salvage and liver re-transplantation on ECMO. Curr Opin Organ Transplant 26:456–457
doi: 10.1097/MOT.0000000000000894
pubmed: 34074942
Dalton HJ, Reeder R, Garcia-Filion P, Holubkov R, Berg RA, Zuppa A, Moler FW, Shanley T, Pollack MM, Newth C, Berger J, Wessel D, Carcillo J, Bell M, Heidemann S, Meert KL, Harrison R, Doctor A, Tamburro RF, Dean JM, Jenkins T, Nicholson C, Eunice Kennedy Shriver National Institute of Child H, Human Development Collaborative Pediatric Critical Care Research N (2017) Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation. Am J Respir Crit Care Med 196:762–771
doi: 10.1164/rccm.201609-1945OC
pubmed: 28328243
pmcid: 5620676
Bulut Y, Sapru A, Roach GD (2020) Hemostatic balance in pediatric acute liver failure: epidemiology of bleeding and thrombosis, physiology, and current strategies. Front Pediatr 8:618119
doi: 10.3389/fped.2020.618119
pubmed: 33425821
pmcid: 7786276
Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL Jr, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, Meckler GD, Roberts KE, Sutton RM, Schexnayder SM, Pediatric B, Advanced Life Support C (2020) Part 4: pediatric basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 142:S469–S523
doi: 10.1161/CIR.0000000000000901
pubmed: 33081526
Nunez JI, Gosling AF, O’Gara B, Kennedy KF, Rycus P, Abrams D, Brodie D, Shaefi S, Garan AR, Grandin EW (2022) Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis. Intensive Care Med 48:213–224
doi: 10.1007/s00134-021-06593-x
pubmed: 34921625
Lisman T, Caldwell SH, Burroughs AK, Northup PG, Senzolo M, Stravitz RT, Tripodi A, Trotter JF, Valla DC, Porte RJ, Coagulation in Liver Disease Study G (2010) Hemostasis and thrombosis in patients with liver disease: the ups and downs. J Hepatol 53:362–371
doi: 10.1016/j.jhep.2010.01.042
pubmed: 20546962
Lobeck IN, Bondoc A, Nolan H, Frischer JS, Campbell KM, Ryan TD, Goldstein SL, Nathan JD, Alonso MH, Tiao GM (2018) Extracorporeal membrane oxygenation in a patient with biliary atresia: case and review of extracorporeal life support organization data. ASAIO J 64:e191–e195
doi: 10.1097/MAT.0000000000000749
pubmed: 29419536
O’Halloran CP, Alexander PMA, Andren KG, Mecklosky J, Salvin JW, Larsen S, Zalieckas J, Fynn-Thompson F, Thiagarajan RR (2018) RBC exposure in pediatric extracorporeal membrane oxygenation: epidemiology and factors associated with large blood transfusion volume. Pediatr Crit Care Med 19:767–774
doi: 10.1097/PCC.0000000000001596
pubmed: 29912067
Getsuwan S, Lertudomphonwanit C, Tanpowpong P, Thirapattaraphan C, Tim-Aroon T, Wattanasirichaigoon D, Treepongkaruna S (2020) Etiologies, prognostic factors, and outcomes of pediatric acute liver failure in Thailand. Pediatr Gastroenterol Hepatol Nutr 23:539–547
doi: 10.5223/pghn.2020.23.6.539
pubmed: 33215025
pmcid: 7667225
Stravitz RT, Lee WM (2019) Acute liver failure. Lancet 394:869–881
doi: 10.1016/S0140-6736(19)31894-X
pubmed: 31498101
pmcid: 10836844
Haidar MK, Morton N, Roederer T, Mayronne S, Bawo L, Kerkula J, Porten K, Baud FJ (2020) Evaluating lactate prognostic value in children suspected of acetaminophen-induced liver failure in Liberia. Pediatr Res 88:605–611
doi: 10.1038/s41390-020-0783-z
pubmed: 31995809
Masha L, Peerbhai S, Boone D, Shobayo F, Ghotra A, Akkanti B, Zhao Y, Banjac I, Gregoric ID, Kar B (2019) Yellow means caution: correlations between liver injury and mortality with the use of VA-ECMO. ASAIO J 65:812–818
doi: 10.1097/MAT.0000000000000895
pubmed: 30312207
Shah N, Li X, Shanmugham P, Fan E, Thiagarajan RR, Venkataraman R, Raman L (2023) Early changes in arterial partial pressure of carbon dioxide and blood pressure after starting extracorporeal membrane oxygenation in children: extracorporeal life support organization database study of neurologic complications. Pediatr Crit Care Med 24:541–550
doi: 10.1097/PCC.0000000000003216
pubmed: 36877009
Deep A, Grammatikopoulos T, Heaton N, Verma A, Dhawan A (2022) Outbreak of hepatitis in children: clinical course of children with acute liver failure admitted to the intensive care unit. Intensive Care Med 48:958–962
doi: 10.1007/s00134-022-06765-3
pubmed: 35687162
pmcid: 9184811
Howard TS, Kalish BT, Rajagopal SK, Williams K, Zalieckas J, Thiagarajan RR, Alexander PMA (2018) Factors associated with mortality in children who successfully wean from extracorporeal membrane oxygenation. Pediatr Crit Care Med 19:875–883
doi: 10.1097/PCC.0000000000001642
pubmed: 29965888
Jain AK, Anand R, Lerret S, Yanni G, Chen JY, Mohammad S, Doyle M, Telega G, Horslen S (2021) Outcomes following liver transplantation in young infants: data from the SPLIT registry. Am J Transplant 21:1113–1127
doi: 10.1111/ajt.16236
pubmed: 32767649