116 K . Komeswaran et al .: J Extra Corpor Technol 2024 , 56 , 114 – 119
Table 1 . Demographic and clinical features of patient cohorts receiving ECMO , IVA + ECMO , and IVA .
Volatile anesthetic agent alone ( n = 1 )
Volatile anesthetic agent followed by ECMO ( n = 5 )
Age ( years ) ( median , IQR ) |
4 |
5 ( 2 , 8 ) |
4 |
Weight ( kg ) ( median , IQR ) |
22 |
17.9 ( 11.2 , 35.0 ) |
12.8 |
Males ( n , %) |
1 |
4 ( 80 ) |
0 |
|
PICU asthma medications ( n ,%)
Methylprednisolone a
|
1 |
5 ( 100 ) |
1 |
Inhaled Albuterol b |
1 |
5 ( 100 ) |
1 |
Magnesium sulphate c |
1 |
5 ( 100 ) |
1 |
Aminophylline d |
1 |
5 ( 100 ) |
1 |
Terbutaline e |
1 |
5 ( 100 ) |
0 |
Mechanical ventilation days ( median , IQR ) |
14 |
14.35 ( 11 , 38 ) |
42 |
Hospital length of stay ( median , IQR ) |
38 |
37 ( 13 , 78 ) |
78 |
a Methylprednisolone 1 mg / kg q6h or max dosing of 80 mg BID IV . b Albuterol dosing for all patients weight based ( 5 – 15 mg ) as a continuous inhaled infusion or q2h . c Magnesium sulfate dosing titrated for goal Magnesium level 4 – 6 mg / dL ( range 25 – 30 mg / kg / h ). d Aminophylline drip with dosing range 0.5 – 1 mg / kg / h , 2 patients received a bolus of 6 mg / kg prior to drip . e Terbutaline dosing 1 – 2 mcg / kg / min .
ECMO alone ( n = 1 )
Table 2 . Comparison of clinical parameters of patients who received inhaled volatile anesthesia and subsequently ECMO as rescue therapy for status asthmaticus .
Patient
Total ECMO run time ( hours )
ECMO type
Ventilator hours prior to ECMO initiation
Hours on IVA before ECMO use
Ventilator hours after ECMO until extubation
Complications
1 |
176 |
VV |
128 |
1.5 |
937 |
Occipital hematoma |
N |
2 |
48 |
VV |
4 |
0.25 |
48 |
n / a |
N |
3 |
168 |
VV |
88 |
46 |
– |
n / a |
N |
4 |
192 |
VV > VA * |
120 |
120 |
720 |
Mortality |
Y |
5 |
144 |
VA |
72 |
54 |
96 |
Infarct |
N |
* Patient initially started on VV ECMO and converted to VA ECMO . Abbreviations : VV – venovenous ; VA – venoarterial .
Mortality
Table 3 . Change in pH , CO 2 , mean airway pressure ( MAP ) and peak inspiratory pressure ( PIP ) prior to rescue therapy ( IVA and / or ECMO ) and after .
Patient
Prerescue therapy
First gas after Initiation of IVA
pH CO 2 MAP Pip
First gas after ECMO cannulation
Prerescue therapy
First gas after initiation of IVA
First gas after ECMO cannulation
Prerescue therapy
On IVA
On ECMO
Prerescue therapy
1 |
7.27 |
7.34 |
7.46 |
81 |
90 |
58 |
20 |
17 |
13 |
45 |
45 |
32 |
2 |
6.97 |
6.93 |
7.09 |
114 |
110 |
78 |
31 |
14 |
12 |
60 |
50 |
33 |
3 |
7.01 |
7.13 |
7.48 |
102 |
125 |
56 |
18 |
11 |
13 |
18 |
32 |
28 |
4 |
7.0 |
7.0 |
7.25 |
125 |
60 |
83 |
11 |
11 |
11 |
30 |
22 |
16 |
5 |
7.08 |
7.24 |
7.27 |
99 |
65 |
86 |
21 |
14 |
12 |
30 |
28 |
24 |
6 |
7.03 |
7.21 |
n / a |
103 |
183 |
n / a |
7 |
14 |
n / a |
32 |
30 |
n / a |
7 |
7.28 |
n / a |
7.42 |
79 |
n / a |
66 |
26 |
n / a |
14 |
40 |
n / a |
27 |
On IVA
On ECMO
Table 3 describes patient ’ s blood gas and ventilator data at multiple time points . Patients had a mean initial pH of 7.08 with an improvement to an average of 7.17 after IVA and improvement to 7.32 after cannulation . PaCO 2 levels had no consistent notable improvement in hypercarbia after IVA administration but were found to decrease by an average of
20 points after ECMO cannulation . All patients who were escalated from IVA to ECMO (# 1 – 5 ) had persistent bronchospasm despite IVA , and 4 of the 5 had persistent acidosis . The timing of the decision was left to the decision of the medical team , and it is unknown if patients had toxicity from IVA contributing to the decision for ECMO . The MAP decreased similarly on IVA