Decompressive laparotomy for abdominal compartment syndrome in children on ECMO: Effect on Support and Survival

Purpose: Abdominal compartment syndrome (ACS) may complicate ECMO due to significant fluid shifts resulting in tense ascites and interstitial edema. This compromises venous cannula flow leading to inadequate patient support. It is debatable whether decompressive laparotomy should be performed in these patients due to the risk of bleeding and poor prognosis. We sought to evaluate the effect of decompressive laparotomy on ECMO support and patient survival. Methods: We reviewed our tertiary care children's hospital ECMO registry (2000-2011) identifying those who underwent decompressive laparotomy. All had ACS as characterized by abdominal hypertension with abdominal distention, hemodynamic instability, oliguria, rising central venous pressures, and inadequate venous return to the ECMO circuit. Physiologic parameters immediately before and 60 min after laparotomy were compared using a signed rank test. Results: Seven patients were identified. ACS developed within 8 h of initiating ECMO in 6 patients. Decompressive laparotomy resulted in significant improvement of patient physiologic parameters and ECMO venous return. One patient had significant bleeding following laparotomy. There were no survivors but three were organ donation candidates after stabilization via decompressive laparotomy. Conclusion: Decompressive laparotomy for ACS in patients on ECMO markedly improves support and tissue perfusion. While in our series ECMO complicated by ACS carries a poor prognosis, we cannot confidently define this as futile therapy due to the limited sample size. (C) 2013 Elsevier Inc. All rights reserved.