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Browsing by Author "Dalton, Heidi"
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Item Candidacy for Extracorporeal Life Support in Children After Hematopoietic Cell Transplantation: A Position Paper From the Pediatric Acute Lung Injury and Sepsis Investigators Network's Hematopoietic Cell Transplant and Cancer Immunotherapy Subgroup(Wolters Kluwer, 2022) Zinter, Matt S.; McArthur, Jennifer; Duncan, Christine; Adams, Roberta; Kreml, Erin; Dalton, Heidi; Abdel-Azim, Hisham; Rowan, Courtney M.; Gertz, Shira J.; Mahadeo, Kris M.; Randolph, Adrienne G.; Rajapreyar, Prakadeshwari; Steiner, Marie E.; Lehmann, Leslie; Hematopoietic Cell Transplant and Cancer Immunotherapy Subgroup of the PALISI Network; Pediatrics, School of MedicineObjectives: The last decade has seen improved outcomes for children requiring extracorporeal life support as well as for children undergoing hematopoietic cell transplantation. Thus, given the historically poor survival of hematopoietic cell transplantation patients using extracorporeal life support, the Pediatric Acute Lung Injury and Sepsis Investigators' hematopoietic cell transplantation and cancer immunotherapy subgroup aimed to characterize the utility of extracorporeal life support in facilitating recovery from critical cardiorespiratory illnesses in pediatric hematopoietic cell transplantation patients. Data sources: All available published data were identified using a set of PubMed search terms for pediatric extracorporeal life support and hematopoietic cell transplantation. Study selection: All articles that provided original reports of pediatric hematopoietic cell transplantation patients who underwent extracorporeal life support were included. Sixty-four manuscripts met search criteria. Twenty-four were included as primary reports of pediatric hematopoietic cell transplantation patients who underwent extracorporeal life support (11 were single case reports, four single institution case series, two multi-institution case series, and seven registry reports from Extracorporeal Life Support Organization, Pediatric Heath Information System, and Virtual Pediatric Systems). Data extraction: All 24 articles were reviewed by first and last authors and a spread sheet was constructed including sample size, potential biases, and conclusions. Data synthesis: Discussions regarding incorporation of available evidence into our clinical practice were held at biannual meetings, as well as through email and virtual meetings. An expert consensus was determined through these discussions and confirmed through a modified Delphi process. Conclusions: Extracorporeal life support in hematopoietic cell transplantation patients is being used with increasing frequency and potentially improving survival. The Pediatric Acute Lung Injury and Sepsis Investigators hematopoietic cell transplantation-cancer immunotherapy subgroup has developed a framework to guide physicians in decision-making surrounding extracorporeal life support candidacy in pediatric hematopoietic cell transplantation patients. In addition to standard extracorporeal life support considerations, candidacy in the hematopoietic cell transplantation population should consider the following six factors in order of consensus agreement: 1) patient comorbidities; 2) underlying disease necessitating hematopoietic cell transplantation; 3) hematopoietic cell transplantation toxicities, 4) family and patient desires for goals of care; 5) hematopoietic cell transplantation preparatory regimen; and 6) graft characteristics. Although risk assessment may be individualized, data are currently insufficient to clearly delineate ideal candidacy. Therefore, we urge the onco-critical care community to collaborate and capture data to provide better evidence to guide physicians' decision-making in the future.Item Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1 - Adult patients(Elsevier, 2019-11) Lorusso, Roberto; Raffa, Giuseppe Maria; Alenizy, Khalid; Sluijpers, Niels; Makhoul, Maged; Brodie, Daniel; McMullan, Mike; Wang, I-Wen; Meani, Paolo; MacLaren, Graeme; Kowalewski, Mariusz; Dalton, Heidi; Barbaro, Ryan; Hou, Xao-Tung; Cavarocchi, Nicholas; Chen, Yih-Sharng; Thiagarajan, Ravi; Alexander, Peta; Alsoufi, Bahaaldin; Bermudez, Christian A.; Shah, Ashish S.; Haft, Jonathan; D’Alessandro, David A.; Boeken, Udo; Whitman, Glenn J.R.; Medicine, School of MedicineCardiogenic shock, cardiac arrest, acute respiratory failure, or a combination of such events, are all potential complications after cardiac surgery which lead to high mortality. Use of extracorporeal temporary cardio-circulatory and respiratory support for progressive clinical deterioration can facilitate bridging the patient to recovery or to more durable support. Over the last decade, extracorporeal membrane oxygenation (ECMO) has emerged as the preferred temporary artificial support system in such circumstances. Many factors have contributed to widespread ECMO use, including the relative ease of implantation, effectiveness, versatility, low cost relative to alternative devices, and potential for full, not just partial circulatory support. While there have been numerous publications detailing the short and midterm outcomes of ECMO support, specific reports about post-cardiotomy ECMO (PC-ECMO), are limited, single-center experiences. Etiology of cardiorespiratory failure leading to ECMO implantation, associated ECMO complications, and overall patient outcomes may be unique to the PC-ECMO population. Despite the rise in PC-ECMO use over the past decade, short-term survival has not improved. This report, therefore, aims to present a comprehensive overview of the literature with respect to the prevalence of ECMO use, patient characteristics, ECMO management, and in-hospital and early post-discharge patient outcomes for those treated for post-cardiotomy heart, lung, or heart-lung failure.Item Structured review of post-cardiotomy extracorporeal membrane oxygenation: Part 2—pediatric patients(Elsevier, 2019) Lorusso, Roberto; Raffa, Giuseppe Maria; Kowalewski, Mariusz; Alenizy, Khalid; Sluijpers, Niels; Makhoul, Maged; Brodie, Daniel; McMullan, Mike; Wang, I-Wen; Meani, Paolo; MacLaren, Graeme; Dalton, Heidi; Barbaro, Ryan; Hou, Xaotong; Cavarocchi, Nicholas; Chen, Yih-Sharng; Thiagarajan, Ravi; Alexander, Peta; Alsoufi, Bahaaldin; Bermudez, Christian A.; Shah, Ashish S.; Haft, Jonathan; Oreto, Lilia; D’Alessandro, David A.; Boeken, Udo; Whitman, Glenn; Surgery, School of MedicineVeno-arterial extracorporeal membrane oxygenation (ECMO) is established therapy for short-term circulatory support for children with life-treating cardiorespiratory dysfunction. In children with congenital heart disease (CHD), ECMO is commonly used to support patients with post-cardiotomy shock or complications including intractable arrhythmias, cardiac arrest, and acute respiratory failure. Cannulation configurations include central, when the right atrium and aorta are utilized in patients with recent sternotomy, or peripheral, when cannulation of the neck or femoral vessels are used in non-operative patients. ECMO can be used to support any form of cardiac disease, including univentricular palliated circulation. Although veno-arterial ECMO is commonly used to support children with CHD, veno-venous ECMO has been used in selected patients with hypoxemia or ventilatory failure in the presence of good cardiac function. ECMO use and outcomes in the CHD population are mainly informed by single-center studies and reports from collated registry data. Significant knowledge gaps remain, including optimal patient selection, timing of ECMO deployment, duration of support, anti-coagulation, complications, and the impact of these factors on short- and long-term outcomes. This report, therefore, aims to present a comprehensive overview of the available literature informing patient selection, ECMO management, and in-hospital and early post-discharge outcomes in pediatric patients treated with ECMO for post-cardiotomy cardiorespiratory failure.