Individual patient data meta-analysis on awake pediatric extracorporeal life support: Feasibility and safety of analgesia, sedation and respiratory support weaning, and physiotherapy

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Abstract
Objective: Awake Extracorporeal Life Support (aECLS) with active mobilization has gained consensus over time, also within the pediatric community. This individual patient data (IPD) meta-analysis summarizes available evidence on pediatric aECLS, its feasibility, and safety regarding sedation weaning, extubation, and physiotherapy. Methods: PubMed/Medline and Cochrane Database were screened until February 2022. Articles reporting on children (≤18 years) undergoing aECLS were selected. IPD were requested, pooled in a single database, and analyzed using descriptive statistics. Primary outcome was survival to hospital discharge. Secondary outcomes included extubation during ECLS, physiotherapy performed, tracheostomy, and complications. Results: Nineteen articles and 65 patients (males: n = 30/59,50.8%) were included. Age ranged from 2 days to 17 years. ECLS configurations included veno-venous ( n = 42/65, 64.6%), veno-arterial ( n = 18/65, 27.7%) and other ECLS settings ( n = 5/65, 7.7%). Exclusive neck cannulation was performed in 51/65 (78.5%) patients. Extubation or tracheostomy during ECLS was reported in 66.2% ( n = 43/65) and 27.7% ( n = 18/65) of patients, respectively. Physiotherapy was reported as unspecified physical activity ( n = 34/63, 54%), mobilization in bed ( n = 15/63, 23.8%), ambulation ( n = 14/63, 22.2%). Complications were reported in 60.3% ( n = 35/58) of patients, including hemorrhagic (36.2%), mechanical (17.2%), or pulmonary (17.2%) issues, and need for reintubation (15.5%). Survival at discharge was 81.5% ( n = 53/65). Conclusion: Awake ECLS strategy with active physiotherapy can be applied in children from neonatal age. Ambulation is also possible in selected cases. Complications related to such management were limited. Further studies on aECLS are needed to evaluate safety and efficacy of early physiotherapy and define patient selection.

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