ECMO-/ECLS

intravenous fluid without developing pulmonary edema. Children with congenital
heart disease may require more judicious use of intravascular volume expansion.
The response to fluid administration must be carefully monitored and will usually
demonstrate improvements in blood pressure, peripheral perfusion and urine
output. CVP and arterial monitoring may also guide resuscitative efforts.
In the context of the child with severe shock, rapid, goal-directed therapy
has been linked to improved outcomes. [2] This starts upon initial evaluation and
continues for several hours thereafter. Once the “ABC’s” have been established
and proper monitoring has been instituted, rapid volume expansion with 20
mL/kg of crystalloid should be administered over 5 minutes. Basic laboratory
investigations including CBC, electrolytes, glucose, coagulation profile, blood
cultures and blood gas should be procured. If septic shock is suspected, empiric
broad-spectrum antibiotic therapy must also be initiated to cover all potential
offending organisms once blood cultures have been obtained. Antibiotics can be
tailored to the specific organism once culture results are received. Bolus
intravenous fluids can be repeated up to 60 mL/kg within the ensuing 60 minutes.
If the patient still demonstrates poor perfusion, the patient should be intubated.
Invasive monitoring should be secured (central venous catheter and arterial
catheter) concurrently. Inotropic support should also be initiated (see below). An
urgent echocardiogram to evaluate cardiac function and rule out cardiac
defects/obstruction should be considered in patients who do not respond to
therapy in a timely fashion. The goals of therapy are to maintain a CVP > 10 mm
Hg and mean arterial pressures at age-related norms. A conservative blood