PicPod 35: Simon Nadel on Sepsis and ECMO

It’s a difficult time for all of PICU with coronavirus causing international devastation. Stay safe everyone, work hard, do your best.

At the 2019 PICS/PCICS conference in London, Simon Nadel gave a talk on the use of ECMO in very severe sepsis.

There is little which is more frightening in our practice than trying to arrest the unstoppable beast of a runaway sepsis. When we are throwing the kitchen sink: should we be doing ECMO? It *kind of* makes sense…. surely if we offload that sick heart and those struggling lungs then that’s a win?

Not so fast: ECMO is a serious intervention which has risks and cost. What is the evidence base? How often is it used? What is the survival? Is VA or VV ECMO better in these situations? At what predicted mortality does it become, on balance, better to go for ECMO? Is it the same if you have in house ECMO or need transferring?

And what on earth is a Bootstrap procedure?

Reference list for this podcast:

Use of extracorporeal membrane oxygenation and associated outcomes in children hospitalized for sepsis in the United States: A large population-based study. Robb et al, PLOS ONE

Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry. Skinner et al, Journal of Pediatric Surgery

Extracorporeal therapies in pediatric severe sepsis: findings from the pediatric health-care information system . Ruth et al., Critical Care BMC

Defining benefit threshold for extracorporeal membrane oxygenation in children with sepsis-a binational multicenter cohort study. LJ Shlapbach et al, Crit Care 2019

Venoarterial Extracorporeal Membrane Oxygenation Versus Conventional Therapy in Severe Pediatric Septic Shock. Oberender et al, PCCM

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