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An Overview of Mechanical Circulatory Support in Children

Jaquiss, Robert D. B. MD1; Bronicki, Ronald A. MD2,3

Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e318292dca5
Joint Statement on Mechanical Circulatory Support
Abstract

Objective: For children with severe heart failure in whom medical management has failed, mechanical circulatory support in the form of either extracorporeal membrane oxygenation or ventricular assist device represents life-sustaining therapy. This review provides an overview of these two modalities, including a discussion of indications, contraindications, timing, and device selection, as part of the Pediatric Cardiac Intensive Care Society/Extracorporeal Life Support Organization Joint Statement on Mechanical Circulatory Support.

Data Sources, Study Selection, Data Extraction: PubMed was searched using the following terms: ECMO, extracorporeal membrane oxygenation, ventricular assist device, VAD, and pediatric. Case reports, single-center series, multicenter studies, and registry reports were reviewed.

Conclusions: The two technologies have unique advantages and disadvantages and may be considered complementary devices, although they are frequently used in sequence. Either modality may be used as bridge-to-transplant or bridge-to-recovery, and the choice of device and device timing is influenced by the acuity of illness, comorbidities, potential for recovery, and anticipated duration of support.

Author Information

1Department of Surgery, Duke Children's Hospital and Duke University School of Medicine, Durham, NC.

2Department of Pediatrics, Baylor College of Medicine, Houston, TX.

3Cardiac Intensive Care Unit, Texas Children’s Hospital, Houston, TX.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: robert.jaquiss@duke.edu

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies