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Discussion

Cardiac ECMO

Last night we placed a 2.5kg infant on VA ECMO in the OR due to not being able to come off bypass. The infants cardiac defect was a DORV, coarc of aorta, and VSD. She was bleeding profusely and was a challenge to maintain BP and keep the circuit from cutting out.

The docs decided to try Factor VII to help with the bleeding. Have any of you tried this with ECMO pts? I cannot say whether it has helped or not because we are still pushing lots of blood products, more than I ever have being with the ECMO team.

The good news is that we recently started vasopressin which really has help the BP and MAP's stablize. I'm not having to push fluid Q15min!!

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We've used Factor VII in a pediatric patient once. She was an adolescent though. In Canada we have to obtain a special release from the government to use it, so it tends not to be our first line of defence as it were. I don't think we'd ever use it in a kiddie as small as yours for fear of major clotting troubles.

It's amazing how much fluid some of these kids need in the first few days of their run, isn't it? I remember one teenager who got 4 liters of lfuid on my shift... she had a DORV and mitral stenosis. Unfortunately she died a couple of hours after my shift ended. And then I had another little man that we were running PRBCs continuously at a fast clip to keep up with his blood loss and double-pumping his epi. He was in septic shock with 5 straight days of rapid positive klebsiella-in-the-vial cultures. He's seemingly turned the corner and is looking tons better, but we're making very slow changes to keep him from heading the other way again.

I hope your wee one is getting there.

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