Cengiz et al identified risk factors for complications in children undergoing extracorporeal life support (ECLS). These can help identify patients who may require closer monitoring for complications. The authors are from the University of Washington, Children's Hospital in Seattle and the Extracorporeal Life Support Organization.


Patient selection: pediatric patients requiring ECLS


Risk factors associated with decreased survival:

(1) gastrointestinal hemorrhage

(2) serum creatinine concentration > 3.0 mg/dL

(3) need for dialysis

(4) need for inotrope support

(5) need for cardiopulmonary resuscitation (CPR)

(6) hypoglycemia (glucose < 40 mg/dL)

(7) metabolic acidosis with pH < 7.2

(8) hyperbilirubinemia


Most of these reflect multi-organ failure.


Risk factors for serious central nervous system (CNS) complications:

(1) metabolic acidosis (pH < 7.20)

(2) need for bicarbonate

(3) need for inotrope or vasopressor agents

(4) need for cardiopulmonary resuscitation (CPR)

(5) need for left ventricular assist device (VAD) before initiation of ECLS

(6) serum creatinine > 3 mg/dL

(7) presence of myocardial stun on echocardiography

(8) venoarterial ECLS in a patient with respiratory failure as the indication for ECLS


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