Open abdomen during extracorporeal membrane oxygenation is a safe and effective treatment for abdominal compartment syndrome

Joshua Brown; Brielle Warnock; Eamaan Turk; Michael J Hobson; Matthew L Friedman; Brian W Gray

doi:10.1016/j.jpedsurg.2021.11.020

Open abdomen during extracorporeal membrane oxygenation is a safe and effective treatment for abdominal compartment syndrome

J Pediatr Surg. 2022 Sep;57(9):216-222. doi: 10.1016/j.jpedsurg.2021.11.020. Epub 2021 Dec 1.

Authors

Joshua Brown¹, Brielle Warnock¹, Eamaan Turk², Michael J Hobson³, Matthew L Friedman³, Brian W Gray⁴

Affiliations

¹ Indiana University School of Medicine, Indianapolis, IN, USA.
² Dow Medical College, Karachi, Sindh, Pakistan.
³ Indiana University School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care, 705 Riley Hospital Drive RI5900, Indianapolis, IN, 46202, USA; Riley Hospital for Children, Section of Pediatric Critical Care, 705 Riley Hospital Drive, Phase 2, Suite 4900, Indianapolis, IN, 46202, USA.
⁴ Riley Hospital for Children, Section of Pediatric Surgery, 705 Riley Hospital Drive RI2500, Indianapolis, IN, 46202, USA; Indiana University, School of Medicine, Department of Surgery, 545 Barnhill Dr., Emerson Hall, Indianapolis, IN, 46202, USA. Electronic address: graybw@iupui.edu.

PMID: 34953565
DOI: 10.1016/j.jpedsurg.2021.11.020

Abstract

Background/purpose: Decompressive laparotomy and open abdomen for abdominal compartment syndrome have been historically avoided during Extracorporeal Membrane Oxygenation (ECMO) due to seemingly elevated risks of bleeding and infection. Our goal was to evaluate a cohort of pediatric respiratory ECMO patients who underwent decompressive laparotomy with open abdomen at a single institution and to compare these patients to ECMO patients without open abdomen.

Methods: We reviewed all pediatric respiratory ECMO (30 days-18 years) patients treated with decompressive laparotomy with open abdomen at Riley Hospital for Children (1/2000-12/2019) and compared these patients to concurrent respiratory ECMO patients with closed abdomen. We excluded patients with surgical cardiac disease. We assessed demographics, ECMO data, and outcomes and defined significance as p = 0.05.

Results: 6 of 81 ECMO patients were treated with decompressive laparotomy and open abdomen. Open and closed abdomen groups had similar age (p = 0.223) and weight (0.286) at cannulation, but the open abdomen group had a higher reliance on vasoactive medications (Vasoactive Inotropic Score, p = 0.040). Open abdomen group survival was similar to closed abdomen patients (66.7%, vs 62.7%, p = 1). Open abdomen patients had lower incidence of ECMO complications (33.3% vs 83.6%, p = 0.014), but the groups had similar bleeding complications (p = 0.412) and PRBC transfusion volume (p = 0.941).

Conclusion/impact: Pediatric ECMO patients with open abdomen after decompressive laparotomy had similar survival, blood products administered, and complications as those with a closed abdomen. An open abdomen is not a contra-indication to ECMO support in pediatric respiratory patients and should be considered in select patients.

Keywords: Abdominal compartment syndrome; Decompressive laparotomy; Extracorporeal membrane oxygenation; Open abdomen; Pediatric.

Publication types

Review

MeSH terms

Abdomen
Abdominal Cavity*
Child
Extracorporeal Membrane Oxygenation* / adverse effects
Humans
Intra-Abdominal Hypertension* / etiology
Intra-Abdominal Hypertension* / surgery
Retrospective Studies
Treatment Outcome