J Extra Corpor Technol 2024 , 56 , 114 – 119 Ó The Author ( s ), published by EDP Sciences , 2024 https :// doi . org / 10.1051 / ject / 2024008
Available online at : ject . edpsciences . org
ORIGINAL ARTICLE
Outcomes in patients who received ECMO and / or volatile anesthetics as rescue therapies for status asthmaticus w
Kavipriya Komeswaran ( MD ) 1 , * , Deanna Todd Tzanetos ( MD , MSCI ) 2 , Tiffany Wright ( MD ) 2 , and Jamie Furlong Dillard ( DO ) 2
1 University of Mississippi Medical Center , Jackson , MS , USA 2 University of Louisville , Louisville , KY , USA
Received 27 September 2022 , Accepted 22 March 2024
Abstract – Background : In the state of Kentucky , many status asthmaticus ( SA ) patients require care in the Pediatric Intensive Care Unit ( PICU ) and a fraction of these patients may receive “ rescue therapies ” with inhaled volatile anesthetics ( IVA ) and / or Extracorporeal Membrane Oxygenation ( ECMO ). We present a series of such patients with the objective of comparing the clinical parameters of individual patients who received inhaled volatile anesthesia and subsequently the need for ECMO . Methods : Children between 2 and 18 years of age admitted to our PICU from January 2014 to July 2020 with SA were reviewed and categorized as 1 ) patients who received IVA alone , 2 ) patients who received IVA and then subsequently ECMO , and 3 ) patients on ECMO alone . Results : A total of 1772 children with SA episodes were identified with a mortality of 13 patients . Seven children with SA were identified who received either IVA , ECMO , or both . One patient received only IVA , 5 received both IVA and ECMO and one received only ECMO . All received standard asthma therapies of steroids , albuterol , magnesium sulphate , and aminophylline prior to escalation . Six out of seven refractory SA received IVA , and five ( 83 %) of those were subsequently escalated to ECMO . There was an improvement in mean pH after cannulation compared to IVA . pCO 2 levels had no improvement after IVA administration but decreased by an average of 20 points after ECMO . Patients peak inspiratory pressures decreased within the 1st 24 h of ECMO cannulation from a mean of 30 to 18 . There were no other complications related to ECMO placement . Conclusion : While we cannot decisively draw any conclusions from our study due to the small sample , it was noted that there was no clear advantage of using IVA prior to ECMO in our patients . Most patients who received IVA were escalated to ECMO indicating that early ECMO cannulation may be beneficial . Given the high cost and potential complications of both , there is a need for the development of well-defined guidelines for severe SA management in the PICU .
Key words : ECMO , Status asthmaticus , Inhaled volatile anesthetics , Pediatrics .
Introduction
Status asthmaticus ( SA ), defined as persistent wheezing and respiratory distress that fails to respond to conventional medical therapy and leads to respiratory failure , is one of the most common indications for admission to the PICU [ 1 ]. In Kentucky , particularly counties that fall in the “ Ohio Valley Asthma Belt ” are known to be notorious for higher asthma rates in children and with increased severity [ 2 ]. In 2018 , Kentucky had an pediatric asthma prevalence rate of 9.4 % ( compared to national average of 9 %) with mortality rates from asthma of 8.7 / million ( compared to a national average of 11.3 / million ) [ 3 ].
w Presented at 38th annual Children ’ s National Symposium –
Keystone , February 26 – March 1st 2022 * Corresponding author : kkomeswaran @ umc . edu
Although children with respiratory failure secondary to SA predominantly respond to a variety of non-invasive therapies including continuous nebulized beta-adrenergic agonists , corticosteroids , magnesium sulfate , methylxanthines , and noninvasive ventilation , 2 – 20 % of those admitted to the PICU still require intubation and mechanical ventilation [ 4 – 6 ]. Practice patterns for the treatment of SA vary and there are no published guidelines on the treatment of asthmatics sick enough to require the ICU [ 7 ]. The definition of refractory SA and decision to continue the escalation of care is within itself subjective and often secondary to the provider ’ s individual decisions or patient ’ s side effects from medical interventions . This leaves us with a lack of data on the best treatment modalities for patients who “ fail ” standard asthma therapies . When these patients further decompensate , despite aggressive methods , they may receive “ rescue therapies ” with unknown comparative
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https :// creativecommons . org / licenses / by / 4.0 ), which permits unrestricted use , distribution , and reproduction in any medium , provided the original work is properly cited .