［Abstract］　Objective　To summarize the timing, risk and management experience of left atrial drainage during extracorporeal membrane oxygenation(ECMO) for treatment of pediatric refractory heart failure. Methods　From January 2015 to February 2023, the treatment results of 10 refractory heart failure children who were performed ECMO support and left atrial drainage in Children′s Hospital of Zhejiang University School of Medicine were retrospectively analyzed. The databases of PubMed, China National Knowledge Infrastructure(CNKI) and Wanfang were retrieved, and a literature review of left atrial decompression in the pediatric cases with ECMO reported in the databases from January 2000 to February 2023 was conducted. Results　Of the 10 patients, 6 cases suffered from fulminant myocarditis complicated with cardiac shock, and 4 cases had postoperative cardiac shock after congenital heart surgery(Three cases had difficulty in weaning from CPB and 1 case had postoperative cardiac arrest). Six cases died and 4 cases survived. The ECMO duration was 36-476 hours, and the left atrial drainage duration was 36-460 hours. The severe complications included cerebral hernia caused by intracranial hemorrhage(2 cases), cerebral infarction complicated with hemiplegia(2 cases), and left ventricular thrombosis(1 case). The causes of death were irreversible cardiac failure(4 cases) and cerebral hernia(2 cases). The case reports on left atrial decompression in children from four research institutions were retrieved from the literature. The clinical results of our center were compared with those of the literature. Conclusion　Left atrial drainage can effectively unload left ventricular preload and promote the recovery of cardiac function. Reasonable management details such as timing of left atrial drainage, preventing coagulation and optimizing the ratio of systemic circulation to left atrial drainage can reduce the incidence of severe complications.]]> 2023/8/4 12:14:57 ZONG Qing, YANG Li-jun, LIN Ru 8true ［Abstract］　Extracorporeal membrane oxygenation(ECMO) can provide strong circulatory and respiratory support for patients with severe cardiac and pulmonary failure. ECMO is also the primary means of extracorporeal life support for the cardiac and pulmonary failure patients waiting for heart or lung transplantation during the rest period. A large amount of evidence-based medical evidence has confirmed the role of ECMO in the treatment of pediatric acute respiratory distress syndrome(PARDS), but there are few reports on its application in acute respiratory failure caused by other causes. This paper reviews the current application progress of ECMO in pediatric acute respiratory failure.]]> 2023/8/4 12:14:57 DU Yan-qiang, WANG Yi, HONG Xiao-yang 7true ［Abstract］　Objective　To analyze the clinical effectiveness of extracorporeal membrane oxygenation(ECMO)-assisted cardiopulmonary resuscitation(CPR) in the treatment of children with cardiac arrest(CA). Methods　The clinical data of 8 pediatric patients who were admitted to the Pediatric Intensive Care Unit(PICU) of Shanghai Children′s Hospital and received ECMO-assisted CPR treatment due to CA from December 2015 to December 2022 were retrospectively analyzed. These clinical data included primary diseases, pre-CPR Pediatric Sequential Organ Failure Assessment(pSOFA) score and Vasoactive Inotropic Score(VIS), CPR to ECMO diversion time, ECMO placement method, ECMO running time, success rate of ECMO weaning, survival rate at discharge, and laboratory indicators before ECMO diversion and 24 hours after ECMO diversion. Results　Among the 8 pediatric patients with CA who received ECMO-assisted CPR treatment, 5 cases died and 3 cases survived. The success rate of ECMO weaning and the survival rate at discharge were both 37.50%(3/8). Among the patients with primary diseases, 7 cases suffered from fulminant myocarditis and 1 case suffered from septic shock. Right internal jugular vein/carotid artery dissection was performed in 3 cases, and femoral vein/femoral artery catheterization was performed in 5 cases. The median ECMO running time was 50.50(3.00, 210.00)hours. The shortest interval between CPR and ECMO diversion was 18 minutes and the longest interval was 150 minutes. After diversion, 6 cases received bedside continuous renal replacement therapy(CRRT) adjuvant treatment, and 4 cases underwent left ventricular decompression during operation. ECMO-related complications included bleeding(8 cases), disseminated intravascular coagulation(DIC)(6 cases), hemolysis(3 cases), thrombosis(1 case), limb ischemic necrosis(1 case), and neurological injury(1 case). The levels of serum creatinine(Scr) and serum liver enzymes［including alanine aminotransferase(ALT) and aspartate aminotransferase(AST)］ were significantly higher in the pediatric patients 24 hours after ECMO diversion than those in the pediatric patients before ECMO diversion(P<0.05). The level of lactic acid(Lac) in the survival group was significantly lower than that in the death group 24 hours after ECMO diversion(P<0.05). Conclusion　The pediatric patients with ECPR still have a lower survival rate at discharge from the hospital and a high rate of bleeding and coagulation events, and a rapid decrease in Lac level 24 hours after ECMO diversion may indicate a favorable prognosis.]]> 2023/8/4 12:14:57 REN Yu-qian, CUI Yun, ZHOU Yi-ping, et al. 6true ［Abstract］　Objective　To explore the effects of different nutritional intervention strategies on the clinical outcomes of pediatric patients treated with veno-arterial extracorporeal membrane oxygenation(VA-ECMO) after surgery for congenital heart disease. Methods　The clinical data of pediatric patients who underwent surgery for congenital heart disease and received VA-ECMO treatment in Guangdong Provincial People′s Hospital from January 2015 to January 2021 were retrospectively analyzed. According to different nutritional intervention strategies, the pediatric patients were divided into enteral nutrition(EN) group(15 cases), parenteral nutrition(PN) group(33 cases) and mixed nutrition(EN+PN) group(10 cases), and were divided into early EN group(9 cases) and late EN group(16 cases) according to the timing of EN. The primary outcome was in-hospital mortality, while the secondary outcomes were the length of stay in intensive care unit(ICU), total length of stay in hospital, incidence rates of new infections and gastrointestinal complications. The clinical outcomes of the pediatric patients with different nutritional intervention strategies and different timing of EN were compared. Results　There were no significant differences in the in-hospital mortality, length of stay in ICU, total length of stay in hospital and incidence rate of new infections among the EN group, the EN+PN group and the PN group(P>0.05), while there were significant differences in the incidence rates of gastrointestinal complications among the three groups(P<0.05). There were no significant differences in the in-hospital mortality, length of stay in ICU, total length of stay in hospital and incidence rates of new infections and gastrointestinal complications between the early EN group and the late EN group(P>0.05). Conclusion　EN or EN+PN increases gastrointestinal complications, but does not increase in-hospital mortality, length of stay in ICU, total length of stay in hospital and incidence rate of new infections. The timing of EN initiation has no effect on clinical outcomes.]]> 2023/8/4 12:14:57 CHEN Chun-ling, HU Yan, WANG Chun, et al. 5true ［Abstract］　Extracorporeal membrane oxygenation(ECMO) is an important therapy method to treat cardiopulmonary failure in children. Hemorrhage and thrombotic complications are the main causes for the dead patients during ECMO support. At present, there is a lack of specific guidelines and recommendations on anticoagulation, hemorrhage and their monitoring and management during ECMO in children. This paper reviews the recent advances in the management of hemorrhage and thrombotic complications in children with ECMO in recent years, including the pathogenesis, related risk factors for children themselves, clinical monitoring and management, in order to provide new ideas for related diagnosis and treatment.]]> 2023/8/4 12:14:57 XIANG Long, REN Hong 4true ［Abstract］　Septic shock is still an important cause of death in children worldwide. Septic shock can lead to hypotension and hypoperfusion, resulting in reduced oxygen delivery(DO₂) and oxygen supply/oxygen consumption imbalance. Extracorporeal membrane oxygenation(ECMO) can increase DO₂ and oxygen supply, so ECMO has a theoretical basis for treating septic shock. The unsatisfactory therapeutic efficacy of ECMO in the treatment of septic shock is mainly related to the timing of ECMO initiation, the experience of ECMO centers, whether it is central venous intubation and high flow rate of ECMO. This paper reviews the clinical application of extracorporeal membrane oxygenation in septic shock in children.]]> 2023/8/4 12:14:58 CHENG Dong-liang, SHI Chang-song 3true ［Abstract］　Objective　To analyze the etiology of acute respiratory failure(ARF) in children receiving extracorporeal membrane oxygenation(ECMO) support and the effects of clinical factors on the outcomes. Methods　The clinical data of 28 children who were hospitalized in the Pediatric Intensive Care Unit(PICU) of the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2019 to June 2023 and received ECMO supportive treatment due to ARF were collected. The pediatric patients′age, gender, primary diseases, etiology, ECMO support modes, P/F index and lactic acid levels before and after ECMO, Murray lung injury score before ECMO, time of ECMO support, the effects of invasive respiratory support durations before and after ECMO on the outcomes of ECMO were analyzed. Results　Of the 28 pediatric patients with acute respiratory failure who received ECMO treatment, seventeen cases survived and 11 cases died; five cases had bacterial infection, and 9 cases had viral infection, and 6 cases had mixed infection of bacteria and viruses, and 8 cases tested negative for pathogenic microbe. There were no statistically significant differences in the P/F index before ECMO, lactic acid levels, time of ECMO support, and durations of mechanical ventilation before and after ECMO between the survival group and the death group(P>0.05), and the differences in the ECMO support modes were statistically significant(P<0.05). There were no statistically significant differences in the P/F index before and after ECMO, lactic acid levels before and after ECMO, time of ECMO support, duration of mechanical ventilation after ECMO and the outcomes among the bacterial infection group, viral infection group, bacterial+viral mixed infection group and negative pathogenic microbe group(P>0.05). However, there were statistically significant differences in Murray lung injury scores before ECMO among the four groups(P<0.05), and the scores in the bacterial+viral mixed infection group were the highest. Conclusion　Different etiologies have effects on the Murray lung injury score in the lungs, but have no significant effects on the time of ECMO treatment, duration of mechanical ventilation after ECMO and the outcomes of ECMO. In addition, the veno-arterial extracorporeal membrane oxygenation(VA-ECMO) and veno-venous extracorporeal membrane oxygenation(VV-ECMO) modes have effects on the survival outcomes of pediatric patients.]]> 2023/8/4 12:14:58 HUANG Han-wu, LIANG Zhen-hua, WANG Min, et al. 2true ［Abstract］　Objective　To analyze the anticoagulant dosage and efficacy of argatroban in pediatric veno-arterial extracorporeal membrane oxygenation(VA-ECMO). Methods　A retrospective analysis was conducted on five cases of pediatric VA-ECMO patients who were admitted to the Pediatric Intensive Care Unit(PICU) of the People′s Hospital of Guangxi Zhuang Autonomous Region from October 2021 to January 2023, and the use of argatroban as an anticoagulant was focused on the patients. Results　Among the five cases of pediatric patients undergoing VA-ECMO, three cases survived at discharge from the hospital and two cases died, and there were no major bleeding or thrombotic events directly associated with argatroban. Argatroban was administered after initial heparin use and the activated partial thromboplastin time(APTT) goal were achieved. However, there was a dissociation between APTT and activated clotting time of whole blood(ACT). The maintenance dosage of argatroban was relatively low and tended to decrease with weight loss. Platelet levels increased after switching to argatroban anticoagulation, resulting in the extended lifespan of ECMO oxygenator, but no reduction in blood product usage was observed. Conclusion　Argatroban can be used for anticoagulation in pediatric VA-ECMO cases with low levels of antithrombin Ⅲ(AT3) and inadequate anticoagulation with heparin. The initial dosage of argatroban should be conservative and individualized adjustments should be made according to the patients′weight and coagulation parameters.]]> 2023/8/4 12:14:58 LIU Gui-liang, WANG Min, PANG Xiao-rong, et al. 1true