Subscribe to RSS
DOI: 10.1055/s-0037-1598757
Extracorporeal Membrane Oxygenation and Cardiopulmonary Bypass in Pediatric Drowning Patients
Publication History
Publication Date:
03 February 2017 (online)
Objectives: Drowning is the second leading cause of accidental death in children aged 1–14 years and constitutes a major challenge for emergency care personnel. We report our experience with extracorporeal membrane oxygenation (ECMO) and cardiopulmonary bypass in pediatric drowning patients.
Methods: Between May 2009 and June 2016 seven children who had suffered from cardiopulmonary failure due to accidental drowning were treated with ECMO and cardiopulmonary bypass. Medical records and operative notes were reviewed.
Results: Our case series includes two females and five males. Median age at the time of the accident was 3.6 years (3 months - 6.4 years). Two accidents happened in salt water, five in sweet water with a mean submersion time of ~31 minutes (20 - 40 minutes). Upon arrival of the rescue team all patients required cardiopulmonary resuscitation (CPR), vasopressor and inotropic therapy as well as intubation and mechanical ventilation. Indication for CPR was persistent cardiac arrest (n = 6) and pulmonary failure (n = 1). Initial Glasgow Coma Scale score was three in all patients. Mean time from preclinical initiation of CPR to arrival at our institution was 103 minutes (60 - 220 minutes). Upon admission mean body temperature was 26.1°C (20 - 34°C). Arterial blood gases prior to ECMO implantation showed a mean pH of 6.91 (6.8–7.1), a mean lactate level of 19.4 mmol/L (12–28 mmol/L) and a mean potassium level of 5.6 mmol/L (3.8–8 mmol/L) indicating severe shock. Venoarterial cannulation was performed via median sternotomy in five cases, while peripheral cannulation was used in two patients. Two patients were carefully rewarmed using the heart lung machine before establishing ECMO. One patient was rewarmed using the heart lung machine alone resulting in cardiopulmonary stabilization without any need of additional ECMO therapy. Mean duration of ECMO before successful weaning/ therapy withdrawal was 3.8 days (1 - 7 days).
Two patients (28.5%) survived to discharge with one patient showing an excellent clinical recovery, while the other patient unfortunately suffered from hypoxic brain damage.
Conclusion: ECMO is a resuscitative strategy in pediatric drowning patients that bears the potential to improve outcomes of these children even in seemingly hopeless situations. All efforts should be made to reduce the preclinical interval which remains extensively long in our experience.