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Pediatric ECLS Neurologic management and outcomes

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International survey of neuromonitoring and neurodevelopmental outcome in children and adults supported on extracorporeal membrane oxygenation in Europe

Mirjana Cvetkovic et al.

Summary: Neuromonitoring and neurocognitive/neurodevelopmental follow-up are critically important during and after ECMO. However, there is significant variability in practice across Europe, and only a minority of centers have structured longitudinal follow-up programs. Guidelines and minimum standards should be developed to inform local protocols.

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Utility of cephalic drains in infants receiving extracorporeal membrane oxygenation

Allison T. Rose et al.

Summary: This retrospective cohort study examined the use and outcomes of cephalic drains (CDs) in infants undergoing extracorporeal membrane oxygenation (ECMO). The majority of CDs remained patent and provided additional venous drainage. Mechanical complications were common in patients with CDs, but did not result in clinical consequences.

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Review Pediatrics

Seizures in children undergoing extracorporeal membrane oxygenation: a systematic review and meta-analysis

Guisen Lin et al.

Summary: This study aimed to investigate the incidence of seizures and associated short-term mortality in children undergoing extracorporeal membrane oxygenation (ECMO). The results showed that the incidence of seizures in children requiring ECMO was 15%, with the majority of seizures being subclinical. Children receiving extracorporeal cardiopulmonary resuscitation (ECPR) had a higher incidence of seizures compared to those with respiratory and cardiac indications. Seizures were more frequent in patients undergoing venoarterial (VA) ECMO compared to venovenous (VV) ECMO. Seizures were associated with increased short-term mortality.

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Associations of cephalad drainage in neonatal veno-venous ECMO - A mixed-effects, propensity score adjusted retrospective analysis of 20 years of ELSO data

Numa P. Perez et al.

Summary: This study analyzed the neurologic complications of neonatal Veno-Venous ECMO using VVDL + V and VVDL cannulation. The results showed that compared to VVDL, patients with VVDL + V had higher mortality rates, higher conversion rates to VA ECMO, and higher rates of mechanical and hemorrhagic complications, but there were no differences in neurologic outcomes, pump flows, or mortality.

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Neonatal Carotid Artery and Internal Jugular Vein Management Practices at Extracorporeal Membrane Oxygenation Decannulation: No Standard Approach

Allison F. Linden et al.

Summary: Currently, there are no standardized guidelines for the management of cervical vessels during neonatal extracorporeal membrane oxygenation (ECMO) decannulation. This study investigated the practices of neonatal ECMO decannulation regarding the management of carotid artery and internal jugular vein, use of post-repair anticoagulation, and follow-up imaging. The results showed significant differences in practices between pediatric and cardiothoracic surgeons, highlighting the need for standardized guidelines and further research on short- and long-term outcomes.

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A Systematic Review of Clinical Outcomes After Carotid Artery Ligation Versus Carotid Artery Reconstruction Following Venoarterial Extracorporeal Membrane Oxygenation in Infants and Children

Lindsay A. Gil et al.

Summary: This study summarizes the current literature on clinical outcomes after carotid artery ligation (CAL) and carotid artery reconstruction (CAR) in pediatric and neonatal populations undergoing Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO). The results show that there is still controversy and limited evidence regarding the decision to ligate or reconstruct the carotid artery during decannulation.

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Clinical Guidelines for Routine Neuromonitoring in Neonatal and Pediatric Patients Supported on Extracorporeal Membrane Oxygenation

Poornima Pandiyan et al.

Summary: This disclaimer provides guidelines for routine neuromonitoring in neonatal and pediatric patients on ECMO, emphasizing that these guidelines are not consensus recommendations, and healthcare professionals should use their clinical judgment to make individual treatment decisions based on patient's condition.

ASAIO JOURNAL (2023)

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Routine Neuroimaging: Understanding Brain Injury in Pediatric Extracorporeal Membrane Oxygenation*

Abdelaziz Farhat et al.

Summary: This study aims to describe brain injuries caused by extracorporeal membrane oxygenation in a large cohort of neonatal and pediatric patients. The study found that brain injuries are common in these patients, but the majority of survivors have favorable neurocognitive outcomes.

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Neonatal ECMO survivors: The late emergence of hidden morbidities - An unmet need for long-term follow-up

Aparna Hoskote et al.

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Incidence and predictors of brain infarction in neonatal patients on extracorporeal membrane oxygenation: an observational cohort study

Sarah Kopfer et al.

Summary: A retrospective cohort study was conducted to determine the incidence and predictors of brain infarctions in neonatal patients treated with ECMO. The study found that the incidence of brain infarctions in neonatal ECMO patients may be higher than previously understood. Several predictors, such as high mortality score, sepsis, ECMO mode conversion, continuous renal replacement therapy, and extracranial thrombosis, were identified.

SCIENTIFIC REPORTS (2022)

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Risk Factors for Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation

Launice Melbourne et al.

Summary: Patients on VA ECMO and with longer ECMO duration have an increased risk of brain injury severity. The study suggests that improvements in care may be reducing the incidence of brain injury in neonatal ECMO patients over time.

AMERICAN JOURNAL OF PERINATOLOGY (2021)

Article Pediatrics

Morbidity of conversion from venovenous to venoarterial ECMO in neonates with meconium aspiration or persistent pulmonary hypertension

Beatrix Hyemin Choi et al.

Summary: Infants with MAS/PPHN requiring VA ECMO may experience increased morbidity and mortality if converted from VV support, compared to those initially placed on VA ECMO. VV patients not receiving surfactant or requiring high-frequency ventilation before cannulation are at higher risk of conversion. Conversions from VV-to-VA ECMO remain rare but inferior outcomes should be considered when deciding to offer VV ECMO for MAS/PPHN.

JOURNAL OF PEDIATRIC SURGERY (2021)

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Association of Cerebral Oxymetry with Short-Term Outcome in Critically ill Children Undergoing Extracorporeal Membrane Oxygenation

Meryl Vedrenne-Cloquet et al.

Summary: The study found that impaired cerebral oxygenation during pediatric ECMO was associated with poor short-term outcomes, while cerebral oxygenation above 80% seemed to be protective. Monitoring of cerebral oxygenation may be important to assess the risk of brain injury in children undergoing ECMO.

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Pediatric and neonatal extracorporeal life support: current state and continuing evolution

Brian P. Fallon et al.

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PEDIATRIC SURGERY INTERNATIONAL (2021)

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Common carotid artery imaging after vessel sparing decannulation from Extracorporeal Membrane Oxygenation (ECMO) support

Jessica L. Carpenter et al.

Summary: The study showed that repair of the right common carotid artery with a simple VST technique can be safely and consistently achieved during VA ECMO support in pediatric patients. Vascular imaging revealed normal right CCA in almost half of the patients, with successful repeat cannulation in the majority of those needing additional VA ECMO support.

JOURNAL OF PEDIATRIC SURGERY (2021)

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Multisite Veno-Venous Cannulation for Neonates and Nonambulatory Children*

Jon Lillie et al.

Summary: This study reported on the use of VV extracorporeal membrane oxygenation in neonates and children under 10 kg, accessing the jugular and returning to the femoral vein. The procedure was technically successful and post-decannulation follow-up showed no clinical implications.

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Anticoagulation and Transfusion Management During Neonatal and Pediatric Extracorporeal Membrane Oxygenation: A Survey of Medical Directors in the United States*

Caroline P. Ozment et al.

Summary: Comparison of anticoagulation management and blood transfusion practices in neonatal and pediatric extracorporeal membrane oxygenation patients in the United States shows wide variations, with most centers using heparin as the primary anticoagulant and a combination of monitoring assays. Platelet transfusion thresholds vary widely, highlighting the need for future research to establish optimal management strategies.

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Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study

Marianne E. Nellis et al.

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Extracorporeal Life Support Organization (ELSO) Guidelines for Follow-up After Neonatal and Pediatric Extracorporeal Membrane Oxygenation

Hanneke Ijsselstijn et al.

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Germinal Matrix-Intraventricular Hemorrhage: A Tale of Preterm Infants

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Factors Associated with Bleeding and Thrombosis in Children Receiving Extracorporeal Membrane Oxygenation

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