With ECMO in the news in both ARDS and Pediatric eCPR, a quick description of what it entails in this summary
A small retrospective study of 56 Pediatric cardiac arrests (80% related to primary cardiac conditions), mean age 3.5 months (1-53).
Survival to hospital discharge was a very good c. 65%, best in younger age (3.5 months) and those with decreased extracorporeal CPR tones and those exposed to therapeutic hypothermia. Follow up showed a good quality of life and family functioning. Further studies are needed to establish whether the technique should be more widely available in Pediatric critical care.
A study of severe adverse pediatric anesthesia events across Europe, e.g. respiratory, cardiac, neurological, allergic. Intubation was a marker for increased adverse events, as was emergency surgery, and case volume / pediatric experience of the providers. Children younger than 3 years and those with prematurity, genetic/metabolic/neurological comorbitities, snoring, airway reactivity, with fever or taking medication are at increased risk of severe critical events and should be anesthetized in high-volume pediatric centres.
“In this study, there was no association between fasting duration and any type of adverse event. These findings do not support delaying sedation to meet established fasting guidelines”.
An observational study sparse on details on what sedation was used, depth of sedation and the procedures in ER. And the rate of vomiting was 5% but they evidently mostly got away with it. A study unlikely to convince anesthesiologists to abandon ASA and other fasting guidelines in this Pediatric population (or adults).
Australians weigh in on the ongoing concern and uncertainty. A statement says that a single exposure to anaesthetic drugs of less than three hours before three years of age does not lead to reduced developmental scores. While not an outright denial of anesthesia’s potential effects it seeks to allay parents’ anxiety.
In children allowed clear fluid intake until premedication, there was no difference in gastric pH but there may be increased residual volume in the most liberal groups. Recent evidence has suggested 1 hour fasting for clear fluids and caution may be needed in too liberal a regime, here around 30 mins
A story that just won’t go away, and there must be reason for concern regarding the Pediatric brain and anesthesia. This time from Australia, with the conclusion:
”Children exposed to general anesthesia before 4 years have poorer development at school entry and school performance. While the association among children with 1 hospitalization with 1 general anesthesia and no other hospitalization was attenuated, poor numeracy outcome remained.”