top of page

Topic:

Compartment Syndrome

Issue:

​

Category:

​

Title:

Acute Compartment Syndrome in Pediatric Patients on Extracorporeal Membrane Oxygenation Support

Author:

Bridges, Callie S. BS; Taylor, Tristen N. BS; Bini, Thomas BS; Ontaneda, Andrea M. MD; Coleman, Ryan D. MD; Hill, Jaclyn F. MD; Montgomery, Nicole I. MD; Shenava, Vinitha R. MD; Gerow, Frank T. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p e285-e291, DOI: 10.1097/BPO.0000000000002592

Level Of Evidence:

IV

# of Patients:

18 children (out of 343 VA ECMO patients)

Study Type:

Retrospective case series

Location:

Single-center study (exact location not mentioned)

Summary:

This study examines the presentation, diagnosis, treatment, and outcomes of pediatric patients on VA ECMO who developed acute compartment syndrome (ACS). The study explores risk factors, fasciotomy outcomes, and complications associated with ACS in these critically ill children.

Methods:

Patient Selection: Children under 19 years old on VA ECMO support from January 2016 to December 2022 who developed ACS. Data Collected: Included cannulation sites, fasciotomy findings, amputation, mortality, and functional outcomes at the last follow-up. Outcomes Evaluated: Mortality rate, need for fasciotomy, muscle findings, and long-term outcomes (amputation, contractures, foot drop).

Exclusions:

Not specified

Results:

Incidence: 18 (5.2%) of 343 patients on VA ECMO developed ACS, with a median of 29 hours after ECMO initiation. Risk Factor: Femoral artery cannulation was significantly associated with ACS (odds ratio=6.0, P<0.0001). Fasciotomy: 78% of patients with ACS underwent fasciotomy, but muscle necrosis had already begun in most cases by the time ACS was diagnosed. Complications: 56% mortality in the hospital. Among survivors, 2 required amputations, 3 developed equinus contracture, 1 developed foot drop, and 3 had no deficits. 1 non-fasciotomy patient required bilateral amputations. No significant infections post-fasciotomy. Fasciotomy Timing: Fasciotomy was performed a median of 1.2 hours after ACS diagnosis.

Conclusions:

ACS in pediatric ECMO patients can occur with or without femoral artery cannulation. Fasciotomy was not always performed early enough to prevent muscle necrosis. The role of fasciotomy in improving outcomes is uncertain, but early recognition and treatment of ACS is critical. The study highlights the need for heightened awareness and prompt diagnosis of ACS in critically ill pediatric patients on ECMO.

Relevance:

Limitations:

Perspective:

bottom of page