Therapeutic plasma exchange in children is increasingly recognized as a life-saving treatment and is challenged by some technical considerations. As extracorporeal membrane oxygenation has been used for nearly half a century for refractory reversible respiratory and/or cardiac failure in both pediatric and adult populations, it may serve as an extracorporeal platform for therapeutic plasma exchange. It is most commonly described in patients with sepsis with multiple organ failure or thrombocytopenia associated multi organ failure. Additional pathophysiological processes of inflammatory and immunological storms might benefit from the combination of extracorporeal membrane oxygenation and plasma exchange. This is a nonmethodological review of English-language reports of therapeutic plasma exchange performed in patients supported by extracorporeal membrane oxygenation, both pediatric and adult, searching six databases, MEDLINE, Clinical Key, GOOGLE SCHOLAR, CINAHL, Cochrane library, and EMBASE.
WeissPFKlinkAJFriedmanDF, et al. Pediatric therapeutic plasma exchange indications and patterns of use in US children’s hospitals. J Clin Apher2012; 27(6): 287–294.
2.
ClarkWFHuangSS.Introduction to therapeutic plasma exchange. Transfus Apher Sci2019; 58(3): 228–229.
3.
McLeodBCSniecinskiICiavarellaD, et al. Frequency of immediate adverse effects associated with therapeutic apheresis. Transfusion1999; 39(3): 282–288.
4.
CanterMODanielsJBridgesBC.Adjunctive therapies during extracorporeal membrane oxygenation to enhance multiple organ support in critically ill children. Front Pediatr2018; 6: 78.
5.
EyreMHacohenYBartonC, et al. Therapeutic plasma exchange in pediatric neurology: a critical review and proposed treatment algorithm. Dev Med Child Neurol2018; 60(8): 765–779.
6.
BelousovaTTongYBaiY, et al. Utilization of therapeutic plasma exchange for hyper-bilirubinemia in a premature new-born on extracorporeal membrane oxygenation. J Clin Apher2019; 34(5): 615–622.
7.
KawaiYCornellTTCooleyEG, et al. Therapeutic plasma exchange may improve hemodynamics and organ failure among children with sepsis-induced multiple organ dysfunction syndrome receiving extracorporeal life support. Pediatr Crit Care Med2015; 16(4): 366–374.
8.
DyerMNealMDRollins-RavalMA, et alSimultaneous extracorporeal membrane oxygenation and therapeutic plasma exchange procedures are tolerable in both pediatric and adult patients. Transfusion2014; 54(4): 1158–1165.
9.
DellgrenGKoiralaBSakopoulusA, et al. Pediatric heart transplantation: improving results in high-risk patients. J Thorac Cardiovasc Surg2001; 121(4): 782–791.
10.
BridgesBCHardisonDPietschJ.A case series of the successful use of ECMO, continuous renal replacement therapy, and plasma exchange for thrombocytopenia-associated multiple organ failure. J Pediatr Surg2013; 48(5): 1114–1117.
11.
ConradLSABromanLMTacconeFS, et alThe extracorporeal life support organization maastricht treaty for nomenclature in extracorporeal life support. A position paper of the extracorporeal life support organization. Am J Respir Crit Care Med2018; 198(4): 447–451.
HenschLAHuiSRTeruyaJ.Coagulation and bleeding management in pediatric extracorporeal membrane oxygenation: clinical scenarios and review. Front Med (Lausanne)2019; 5: 361.
14.
ChongMLopez-MagallonAJSaenzL, et al. Use of therapeutic plasma exchange during extracorporeal life support in critically ill cardiac children with thrombocytopenia-associated multi-organ failure. Front Pediatr2017; 5: 254.
15.
ZhangL.ZhaiHMaS, et al. Efficacy of therapeutic plasma exchange in severe COVID-19 patients. Br J Haematol2020;190(4): e181–e183.
16.
CortinaGMcRaeRChilettiR, et alTherapeutic plasma exchange in critically ill children requiring intensive care. Pediatr Crit Care Med2018; 19(2): e97–e104.
17.
JhangJMiddlesworthWShawR, et al. Therapeutic plasma exchange performed in parallel with extra corporeal membrane oxygenation for antibody mediated rejection after heart transplantation. J Clin Apher2007; 22(6): 333–338.
18.
BusundRKouklineVUtrobinU, et al. Plasmapheresis in severe sepsis and septic shock: a prospective, randomized, controlled trial. Intensive Care Med2002; 28(10): 1434–1439.
19.
RimmerEHoustonBLKumarA, et al. The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis. Crit Care2014; 18(6): 699.
20.
NguyenTCHanYYKissJE, et al. Intensive plasma exchange increases a disintegrin and metalloprotease with thrombospondin motifs-13 activity and reverses organ dysfunction in children with thrombocytopenia-associated multiple organ failure. Crit Care Med2008; 36(10): 2878–2887.
LoMHHuangCFChangLS, et al. Drug reaction with eosinophilia and systemic symptoms syndrome associated myocarditis: a survival experience after extracorporeal membrane oxygenation support. J Clin Pharm Ther2013; 38(2): 172–174.
23.
PrestonTJDaltonHJNicolKK, et al. Plasma exchange on venovenous extracorporeal membrane oxygenation with bivalirudin anticoagulation. World J Pediatr Congenit Heart Surg2015; 6(1): 119–122.
24.
EyreMHacohenYBartonC, et al. Therapeutic plasma exchange in pediatric neurology: a critical review and proposed treatment algorithm. Dev Med Child Neurol2018; 60(8): 765–779.
25.
ChengAWilliamsFFortenberryJ, et al. Use of extracorporeal support in hemophagocytic lymphohistiocytosis secondary to ehrlichiosis. Pediatrics2016; 138(4): e20154176.
26.
AgarwalHSTaylorMBGrzeszczakMJ, et al. Extra corporeal membrane oxygenationand plasmapheresis for pulmonary hemorrhage in microscopicpolyangiitis. Pediatr Nephrol2005; 20(4): 526–528.
27.
JamesD.FortenberryMD.Pediatric critical care management of septic shock prior to acute kidney injury and renal replacement therapy. Semin Nephrol2008; 28(5): 447–456.
28.
ChoJHParillaMTremlA, et al. Plasma exchange for heparin-induced thrombocytopenia in patients on extracorporeal circuits: a challenging case and a survey of the field. J Clin Apher2019; 34(1): 64–72.
