In this World Shared Practice Forum Podcast, Dr. Graeme MacLaren shares his expert insight on the outcomes of central versus peripheral cannulation techniques for Extracorporeal Membrane Oxygenation (ECMO) in pediatric patients with refractory septic shock as published in the February issue of Pediatric Critical Care Medicine. The discussion focuses on the implications of ECMO modality choices, the conditions affecting cannulation strategy, and how institutional resources can impact patient outcomes.
LEARNING OBJECTIVES
- Differentiate between central and peripheral venoarterial ECMO strategies in pediatric septic shock
- Analyze key papers in the literature to provide context for decision-making around ECMO deployment in refractory septic shock
- Identify factors influencing the success and outcome of ECMO in refractory pediatric septic shock cases
- Apply considerations for patient selection and institutional resource availability in ECMO planning
AUTHORS
Graeme MacLaren, MBBS, MSc, FRACP, FCICM, FCCM, FELSO
Director of Cardiothoracic Intensive Care,
National University Hospital, Singapore
Clinical Director of ECMO, National University Heart Centre, Singapore
Adjunct Professor, Department of Surgery, National University of Singapore
Past President, Extracorporeal Life Support Organization
Jeffrey Burns, MD, MPH
Emeritus Chief
Division of Critical Care Medicine
Department of Anesthesiology, Critical Care and Pain Medicine
Boston Children's Hospital
Professor of Anesthesia
Harvard Medical School
DATE
Initial publication date: March 24, 2025.
ARTICLES REFERENCED
1) MacLaren, Graeme MBBS, MSc, FELSO, FCCM. Cannulation Strategies for Extracorporeal Membrane Oxygenation in Children With Refractory Septic Shock. Pediatric Critical Care Medicine ():10.1097/PCC.0000000000003707, February 10, 2025. | DOI: 10.1097/PCC.0000000000003707
2) Totapally A, Stark R, Danko M, et al. Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Sepsis: Outcomes Comparison in the Extracorporeal Life Support Organization Dataset, 2000-2021. Pediatr Crit Care Med. Published online January 23, 2025. doi:10.1097/PCC.0000000000003692
3) Schlapbach LJ, Chiletti R, Straney L, et al. Defining benefit threshold for extracorporeal membrane oxygenation in children with sepsis-a binational multicenter cohort study. Crit Care. 2019;23(1):429. Published 2019 Dec 30. doi:10.1186/s13054-019-2685-1
4) Bréchot N, Hajage D, Kimmoun A, et al. Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study. Lancet. 2020;396(10250):545-552. doi:10.1016/S0140-6736(20)30733-9
TRANSCRIPT
https://cdn.bfldr.com/D6LGWP8S/at/84gbxthfmhvp7v9fsnjb87mh/0320425_WSP_MacLaren_Transcript.pdf
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CITATION
MacLaren G, Burns JP. Pediatric ECMO Cannulation Strategies in Refractory Septic Shock. 03/2025. OPENPediatrics. https://soundcloud.com/openpediatrics/pediatric-ecmo-cannulation-strategies-in-refractory-septic-shock-by-g-maclaren-openpediatrics.
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