ECMO-/ECLS

resuscitation. However, all would agree that prompt resuscitation is of utmost
importance. Evidence shows that pediatric burn patients demonstrate a
significant higher incidence of sepsis, renal failure, and mortality if fluid
resuscitation is initiated ≥ 2 hours after the injury. The addition of maintenance
fluids should not be neglected during the initial phase of resuscitation. In
addition, patients with inhalation injury combined with cutaneous burns, have a
greatly increased fluid resuscitation requirement during the first 48 hours.
Resuscitation should be guided by endpoints, such as urine output. Patients
weighing less than 30 kg, should make between 1-1.5 ml/kg/hr. Close
monitoring of the urine output during the first several hours is extremely
important. Proper attention to endpoint titration rather than adhering to rigid
parameters will lead to better resuscitation. Ultimately, the response to fluid
therapy will determine the rate and volume of fluid administration. Children
have a greater BSA relative to their body weight. Weight-based formulas often
under resuscitate children with minor burns and grossly over resuscitate
children with extensive burns. Monitoring the trend of serum base deficit and
lactic acid can also provide useful information regarding the generalized state
of burn shock. The use of invasive monitoring is reserved for severe or
refractory cases of resuscitation, where hemodynamic monitoring will provide
further guidance. Most guidelines for the use of inotropic and hemodynamic
support are based on the general sepsis and shock literature. Norepinephine
or dobutamine are the preferred vasopressors for refractory hypotension.
Dobutamine can provide inotropic support when the cardiac output remains low