In recent years, the use of mechanical support for patients with cardiac or circulatory failure has continuously increased, leading to 3,000 ECLS/ECMO (extracorporeal life support/extracorporeal membrane oxygenation) implantations annually in Germany. Due to the lack of guidelines, there is an urgent need for evidence-based recommendations addressing the central aspects of ECLS/ECMO therapy. In July 2015, the generation of a guideline level S3 according to the standards of the Association of the Scientific Medical Societies in Germany (AWMF) was announced by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS). In a well-structured consensus process, involving experts from Germany, Austria and Switzerland, delegated by 16 scientific societies and the patients' representation, the guideline "Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure" was created under guidance of the GSTCVS, and published in February 2021. The guideline focuses on clinical aspects of initiation, continuation, weaning and aftercare, herein also addressing structural and economic issues. This article presents an overview on the methodology as well as the final recommendations.In den vergangenen Jahren hat der Einsatz mechanischer Unterstützungssysteme für Patienten mit Herz- und Kreislaufversagen kontinuierlich zugenommen, sodass in Deutschland mittlerweile jährlich etwa 3000 ECLS-/ECMO-Systeme implantiert werden. Vor dem Hintergrund bislang fehlender umfassender Leitlinien bestand ein dringlicher Bedarf an der Formulierung evidenzbasierter Empfehlungen zu den zentralen Aspekten der ECLS-/ECMO-Therapie. Im Juli 2015 wurde daher die Erstellung einer S3-Leitlinie durch die Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG) bei der zuständigen Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) angemeldet. In einem strukturierten Konsensusprozess mit Einbindung von Experten aus Deutschland, Österreich und der Schweiz, delegiert aus 11 AWMF-Fachgesellschaften, 5 weiteren Fachgesellschaften sowie der Patientenvertretung, entstand unter Federführung der DGTHG die Leitlinie „Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen“, die im Februar 2021 publiziert wurde. Die Leitlinie fokussiert auf klinische Aspekte der Initiierung, Fortführung, Entwöhnung und Nachsorge und adressiert hierbei auch strukturelle und ökonomische Fragestellungen. Dieser Artikel präsentiert eine Übersicht zu der Methodik und den konsentierten Empfehlungen.

BACKGROUND Persistent air leak (PAL) is a severe complication of secondary spontaneous pneumothorax (SSP). Surgical interventions are usually successful when medical treatment fails, but can be associated with significant complications and loss of potentially recoverable lung parenchyma. METHODS Retrospective analysis of efficacy and safety of interventional bronchus occlusions (IBO) using Amplatzer devices (ADs) in children with PAL secondary to SSP. RESULTS Six patients (four males, 4-15 years of age) underwent IBO using ADs as treatment for PAL. Necrotizing pneumonia (NP) was the most common cause (n=4) of PAL. Three patients were previously healthy and three suffered from chronic lung disease. All patients required at least two chest tubes prior to the intervention for a duration of 15-43 days and all required oxygen or higher level of ventilatory support. In three cases, previous surgical interventions had been performed without success. All children improved after endobronchial intervention and we observed no associated complications. All chest tubes were removed within 5-25 days post IBO. In patients with PAL related to NP (n=4), occluders were removed bronchoscopically without re-occurrence of pneumothorax after a mean of 70 days (IQR: 46.5-94). CONCLUSION IBO using ADs is a safe and valuable treatment option in children with PAL independent of disease severity and underlying cause. A major advantage of this procedure is its less invasiveness compared to surgery and the parenchyma- preserving approach.

Background: The interindividual variability of children's susceptibility to even slightly elevated IAP (intra-abdominal pressure) is unknown, as is the mechanism of transition from IAH (intra-abdominal hypertension = IAP > 10 mm Hg) to abdominal compartment syndrome (ACS = IAH+ organ dysfunction) and/or multiorgan dysfunction syndrome (MODS). Therefore, to improve the monitoring and assessability of micro- and macrocirculation in the context of IAP/IAH/ACS, we developed a multimodal monitoring concept and evaluated it as a prognostic tool.

Introduction: Liver transplantation (LT) in children has undergone significant changes over the last years. Especially the use of split and living donor transplants even for infants has led to new challenges in pre- and post-operative care. Systemic inflammatory response syndromes (SIRS, sepsis) as well-known complications after LT have not yet been systematically examined in the pediatric population. Methods: We analyzed clinical data of 39 pediatric liver transplant recipients regarding potential risk factors for post-transplant SIRS and sepsis. Secondly, the prognostic impact of SIRS and sepsis on post-transplant clinical course, patient and transplant-survival has been analyzed. Results: 64% of patients developed either SIRS (n = 16, 41%) or sepsis (n = 9, 23%) within 30 days after transplantation. No pre-transplant risk factors for increased susceptibility for SIRS or sepsis could be identified. Secondary closure of the abdomen (p = 0.045) and secondary biliary reconstruction (p = 0.043) were associated with a higher incidence of sepsis and were associated with significantly prolonged mechanical ventilation times in the presence of sepsis (p = 0.001). Patients with sepsis, but not SIRS, stayed significantly longer on PICU (p = 0.021) and suffered from higher mortality (n = 3 versus 0; p = 0.0006). All deaths within 30 days of transplantation were due to septic multiorgan failure. Neither early SIRS nor sepsis were associated with loss of transplant function. Conclusions: SIRS and sepsis are frequent events after pediatric liver transplantation. Sepsis increased length of PICU-stay and mortality significantly and prolonged duration of mechanical ventilation. Secondary biliary reconstruction and closure of the abdomen could be identified as potential risk factors for sepsis.

observed no associated complications. All chest tubes were removed within 5–25 days post IBO. In patients with PAL related to NP (n = 4), occluders were removed bronchoscopically without re-occurrence of pneumothorax after a mean of 70 days (IQR: 46.5–94). Conclusion: IBO using ADs is a safe and valuable treatment option in children with PAL independent of disease severity and underlying cause. A major advantage of this procedure is its less invasiveness compared to surgery and the parenchyma- preserving approach.

Objectives: Extracorporeal membrane oxygenation (ECMO) despite its common use in cases of severe cardiopulmonary failure in adult and pediatric patients still remains a challenge in modern intensive medicine. In this study, we analyzed our experience with ECMO support through cervical cannulation in infants and pediatric patients.

Objectives: In neonates the groin vessels, especially the arteries, are at risk for perfusion deficits after catheterization. In low cardiac output this risk might be even increased. Therefore we modified the ECMO circuit with a valve in the arterial line and performed the balloon dilatation of the aortic valve through the ECMO cannula.

Bei einer jugendlichen, bisher gesunden Patientin trat eine rasch progrediente Belastungsdyspnoe auf. Ursächlich war eine zentrale Lungenarterienembolie beider Lungenarterien. Von Beginn der Symptome bis zur Diagnosestellung vergingen jedoch 10 Wochen. Das klinische Bild einer Lungenembolie (LE) bei Kindern ist unspezifisch. Dies führt oft zur späten Diagnosestellung. Daher ist die Anamneseerhebung der Risikofaktoren von hohem Stellenwert. Goldstandard bei Verdacht auf eine LE ist die CT mit Kontrastmittel. Die Therapie beim kreislaufstabilen Patienten erfolgt primär mit unfraktioniertem Heparin und Vitamin-K-Antagonisten.

Objectives: Following the idea of a minimal invasive lung protective strategy in the vulnerable neonatal lung we developed a new extracorporeal approach using a double-lumen cannula via the umbilical vein. Although venovenous extracorporeal lung support (VV-ECLS) is a standard of care procedure in the neonatal population in acute respiratory failure there are no reports regarding the use of a double-lumen cannula via the umbilical vein.

Background: Ultrasound dilution technique (UDT), a novel indicator dilution (ID) method for cardiac output (CO) measurement, detects and quantifies shunts unrestricted by age and catheter location in intensive care patients. However, until now its accuracy and reproducibility in cardiac right-to-left-shunt (RLS) detection has not been investigated.

Background: We previously validated cardiac output measurement by novel ultrasound dilution technique (UDT) and found favorably agree-ment with Fick principle. UDT also determines volumetric parameters such as central blood volume index (CBVI; blood volume of heart, lungs and major vessels) and total end-diastolic volume (TEDVI; sum of all end-diastolic volumes of the atria and ventricles). We evaluated CBVI and TEDVI as cardiac preload parameter.

Grundlage: Bei kinderkardiologischen Patienten kommt es v.a. bei Volu-menüberladung, rechtsventrikulärem Versagen und Inflammation zu IAH/ACS. Im Rahmen dieser Erhebung wurden Wahrnehmung und Be-kanntheitsgrad von Definitionen und Empfehlungen auf ICUs untersucht.

Objectives: In pediatric patients with cardiogenic shock (CS)/or acute cardiac failure (ACF) extracorporeal membrane oxygenation (ECMO) is often used as a bridging procedure to recovery or further implantation of a ventricular assist device (VAD). Although ECMO has been established as a routine procedure in pediatric tertiary care centers, the clinical path guiding these patients to fully recovery or further VAD implantation is one of the most challenging for pediatric intensivists.

We show the effect of a network system in the treatment of pediatric septic shock, especially for children with Waterhouse–Friderichsen syndrome. In 2003 we founded a pediatric intensive care network with 15 children's hospitals in Lower Saxony, Germany. The aims were the standardisation of clinical therapies, implementation of training programs and the installation of an emergency system in the region of lower Saxony.

Adenoviral (AdV) infections after transplantation remain a challenge in pediatric patients. Qualitative and quantitative PCR offer new approaches to early diagnosis and monitoring. However, their role in the management of AdV infections in pediatric transplant recipients remains to be determined. We report six children with positive qualitative serum-PCR for AdV on routine follow-up after transplantation (liver n = 4, hematopoetic stem cells (HSCT) n = 1, combined liver and HSCT n = 1). None of these children were symptomatic at the time of first detection of AdV. Two patients remained asymptomatic, one developed hemorrhagic cystitis and enteritis. Three children with positive PCR developed high viral load on quantitative PCR, all developed clinical AdV sepsis with further rising virus load. Despite antiviral therapy with cidofovir, these three patients died of septic multiorgan failure. Positive qualitative AdV-PCR from blood after pediatric transplantation is not necessarily followed by clinical disease. In case of positive AdV-PCR, monitoring by serial quantitative PCR is useful regarding treatment decision and prevention of fatal disease.