Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov;183(11):5013-5019.
doi: 10.1007/s00431-024-05794-y. Epub 2024 Sep 25.

Is there a role for extracorporeal membrane oxygenation in children with acute liver failure? A retrospective analysis of the Extracorporeal Life Support Organization Registry

Matteo Di Nardo  1 , Raphael Joye  2 , Danilo Alunni-Fegatelli  3 , Vladimir L Cousin  2 , Ravi R Thiagarajan  4 , Serge Grazioli  2 , Peter Rycus  5 , Angelo Polito  2
Affiliations

Is there a role for extracorporeal membrane oxygenation in children with acute liver failure? A retrospective analysis of the Extracorporeal Life Support Organization Registry

Matteo Di Nardo et al. Eur J Pediatr. 2024 Nov.

Abstract

Data describing the use of extracorporeal membrane oxygenation (ECMO) in pediatric acute liver failure (PALF) are scarce. Thus, we aimed to describe the use of ECMO in patients with PALF using the data from the Extracorporeal Life Support Organization (ELSO) Registry between January 1, 2010, to December 31, 2022. We described patients' characteristics at ECMO initiation, outcome, and factors associated with mortality. A total of 335 children underwent ECMO support in the context of PALF. Veno-arterial (VA) ECMO was the most prevalent mode (66.6%), followed by veno-venous (VV) ECMO (33.4%). Extracorporeal cardiopulmonary resuscitation (ECPR) was used in 21.5% of the cardiac arrest. In-hospital mortality was 66.6%. Both higher lactate (OR 1.128, CI 1.06-1.209, p < 0.001) and PaCO2 (OR 1.022, CI 1.001-1.047, p 0.05) levels before ECMO reported greater odds of mortality. Low body weight, persistence of hyperlactatemia (OR 0.985, CI 0.973-0.997, p 0.013), and hyperbilirubinemia (OR 2.477, CI 1.042-6.100, p 0.045) after 24 h from ECMO deployment were associated to greater odds of mortality.

Conclusions: Our results suggest that the use of ECMO for the management of respiratory and cardiac failure in patients with PALF should be considered with caution and that further research is needed to understand its role in this specific high-risk population.

What is known: • Pediatric acute liver failure (PALF) is a clinical syndrome associated with significant morbidity and mortality. • Data on the use of extracorporeal membrane oxygenation (ECMO) in the context of PALF are scarce and controversial.

What is new: • ECMO to manage acute respiratory and/or cardiac failure in the context of PALF should be considered with caution. • Bleeding and thrombotic complications in children with acute liver failure receiving ECMO are similar to the ones reported in the general pediatric population.

Keywords: ECLS; ECMO; Hyperbilirubinemia; Hyperlactatemia; Pediatric liver dysfunction; Pediatric liver failure.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

    1. Deep A, Alexander EC, Bulut Y, Fitzpatrick E, Grazioli S, Heaton N, Dhawan A (2022) Advances in medical management of acute liver failure in children: promoting native liver survival. Lancet Child Adolesc Health 6:725–737 - DOI - PubMed
    1. Squires JE, Alonso EM, Ibrahim SH, Kasper V, Kehar M, Martinez M, Squires RH (2022) North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper on the diagnosis and management of pediatric acute liver failure. J Pediatr Gastroenterol Nutr 74:138–158 - DOI - PubMed
    1. Ascher Bartlett JM, Yanni G, Kwon Y, Emamaullee J (2022) Pediatric acute liver failure: reexamining key clinical features, current management, and research prospects. Liver Transpl 28:1776–1784 - DOI - PubMed - PMC
    1. Zellos A, Debray D, Indolfi G, Czubkowski P, Samyn M, Hadzic N, Gupte G, Fischler B, Smets F, de Clety SC, Grenda R, Mozer Y, Mancell S, Jahnel J, Auzinger G, Worth A, Lisman T, Staufner C, Baumann U, Dhawan A, Alonso E, Squires RH, Verkade HJ (2022) Proceedings of ESPGHAN Monothematic Conference 2020: “acute liver failure in children”: diagnosis and initial management. J Pediatr Gastroenterol Nutr 74:e45–e56 - PubMed
    1. Nandhabalan P, Loveridge R, Patel S, Willars C, Best T, Vercueil A, Vilca-Melendez H, Deep A, Heaton N, Auzinger G (2016) Extracorporeal membrane oxygenation and pediatric liver transplantation, “a step too far? ”: results of a single-center experience. Liver Transpl 22:1727–1733 - DOI - PubMed

LinkOut - more resources