Exploring and Establishment of Combined Extracorporeal Life Support(CELS) in Critically Ill Children

Guoping Lu

Overview

Multiple organ failure (MODS) is still the leading cause of death in children in ICU. The treatment of MODS is mainly organ function monitoring and organ replacement therapy. Life support technology in vitro mainly includes mechanical ventilation, continuous renal replacement therapy (CRRT), non-biological artificial liver and extracorporeal membrane oxygenation technology (ECMO). However, critically ill patients who have multiple organ failure often require multiple organ support meanwhile. Combined extracorporeal life support (CELS) is still in its infancy to be applied in the treatment of critical illness due to nonstandard technology and theory without key breakthroughs and evidence-based medicine in the treatment of severe children organ failure.Solving the system problems supported by CELS can effectively reduce the mortality and disability rate of critically ill children and enhance health care in Shanghai, even across China.

The whole study is described below. To investigate the timing ,curative effect and mode of CRRT and ECMO treatment for critically ill children,we choose sepsis children especially those who are combined with septic shock as research object. Furthermore,refractory shock is the therapeutic indications of ECMO. According to their clinical manifestation and severity of the disease,they are treated by CRRT or/with ECMO in a non-randomized way. Comparing the laboratory index and prognosis of critically ill children treated by CRRT and those treated by ECMO,we aim to investigate the the timing ,curative effect of ECMO in the treatment of septic shock especially refractory shock. The critically ill children who treated by CRRT are divided into three groups according to their treatment mode of CRRT. The laboratory index and prognosis are also be compared to investigate curative effect of CRRT in the treatment of septic shock. The study also include severe sepsis children without CRRT or ECMO treatment as a control group.

Study Type

OBSERVATIONAL

Conditions

Sepsis Critical Illness MODS

Interventions

TreatmentOTHER

The CELS way to intervene severe sepsis and refractory shock

Eligibility

Sex: ALLMin age: 29 DaysMax age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Children with severe sepsis and refractory shock admitted to the PICU of four study centers. The informed consent of the guardians Exclusion Criteria: * active hemorrhage difficult catheter placing Irreversible brain damage patients enrolled in other clinic trial

Locations (1)

Children'S Hosptial of Fudan University

Shanghai, China

Outcomes

Primary Outcomes

survival rate

The survival rate of children in 28 days after their hospital discharged.

Time frame: 28 days

Secondary Outcomes

Pediatric Risk of Mortality score （PRISM III）

The PRISM score is a quantification of physiologic status using predetermined physiologic variables and their ranges that use categorical variables to facilitate accurate estimation of mortality risk.The PRISM components were separated into cardiovascular (heart rate, systolic blood pressure, and temperature), neurologic ( pupillary reactivity and mental status), respiratory (arterial Po2, pH, Pco2, and total bicarbonate), chemical (glucose, potassium, blood urea nitrogen, and creatinine), and hematologic (WBC count, platelet count, prothrombin, and partial thromboplastin time) component.The score above 10 indicates a poor prognosis and higher mortality of critical ill children. The score below 10 indicates a relatively favorable prognosis and lower mortality .

Time frame: the first 24 hours after admitted to PICU

ECMO weaning rate

The success of ECMO weaning is defined as the survival of patients after ECMO is wean for 48 hours

Time frame: 48 hours

Data from ClinicalTrials.gov

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