Acute Compartment Syndrome in Pediatric Patients on Extracorporeal Membrane Oxygenation Support
Callie S. Bridges, Tristen N. Taylor, Thomas Bini, Andrea M. Ontaneda, Ryan D. Coleman, Jaclyn F. Hill, Nicole I. Montgomery, Vinitha R. Shenava, Frank T. Gerow- Orthopedics and Sports Medicine
- General Medicine
- Pediatrics, Perinatology and Child Health
Background:
When acute compartment syndrome (ACS) occurs in pediatric patients requiring venoarterial extracorporeal membrane oxygen (VA ECMO) support, there is little data to guide surgeons on appropriate management. The purpose of this study is to characterize the presentation, diagnosis, timeline, and outcomes of patients who developed this complication.
Methods:
This is a single-center retrospective case series of children below 19 years old on VA ECMO support who subsequently developed extremity ACS between January 2016 and December 2022. Outcomes included fasciotomy findings, amputation, mortality, and documented function at the last follow-up.
Results:
Of 343 patients on VA ECMO support, 18 (5.2%) were diagnosed with ACS a median 29 hours after starting ECMO. Initial cannulation sites included 8 femoral, 6 neck, and 4 central. Femoral artery cannulation was associated with an increased risk of ACS [odds ratio=6.0 (CI: 2.2 to 15),
Conclusions:
Pediatric ECMO-associated ACS is not exclusive to patients with femoral artery cannulation. The majority of fasciotomy patients were diagnosed with ACS after muscle necrosis had already started. We were unable to definitively conclude whether fasciotomies provide better outcomes. There is a need for increased awareness and earlier recognition of this rare yet potentially devastating complication.
Level of Evidence:
Level IV—retrospective case series