About

Adam S. Himebauch, MD, MSCE, is an Associate Professor of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia. He serves as an Attending Physician in the Division of Critical Care Medicine at the Children's Hospital of Philadelphia. Dr. Himebauch is also Co-Director of the Extracorporeal Life Support (ELCS) Clinical Fellowship at the Children's Hospital of Philadelphia. His educational background includes a Bachelor of Arts in Biological Sciences and a Bachelor of Science in Biochemistry from the University of Delaware, obtained in 2000 and 2001 respectively. He earned his MD from the University of Pittsburgh School of Medicine in 2005 and completed a Master of Science in Clinical Epidemiology at the Perelman School of Medicine at the University of Pennsylvania in 2022.

Research topics

• Medicine
• Internal medicine
• Cardiology
• Anesthesia
• Intensive care medicine
• Radiology
• Surgery

Selected publications

• Validation of Lung Ultrasound Score for Disease Severity and Outcomes in Pediatric Acute Respiratory Failure

  Pediatric Critical Care Medicine · 2026-02-16

  articleSenior author

  OBJECTIVES: The objective of this study was to investigate the validity of global lung ultrasound (LUS) scores among critically ill children with different etiologies and severities of acute respiratory failure as well as associations with outcomes. DESIGN: Prospective, observational study. SETTING: PICUs at two large children's hospitals. PATIENTS: Children receiving noninvasive or invasive mechanical ventilation and met criteria for acute respiratory distress syndrome (ARDS), lower respiratory tract infection (LRTI), or control group (no lung disease). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: LUS was performed and LUS scores calculated at two time points: 1) within 24 hours of respiratory failure for all groups (time 1) and 2) at 24 hours of time 1 for patients with ARDS and LRTI (time 2). A total of 76 patients (25 ARDS, 26 LRTI, and 25 control) were included. There was a significant difference in median time 1 global LUS scores between groups (ARDS, 19; interquartile range [IQR], 12-24; LRTI, 8 [IQR, 2-11]; and control, 2 [IQR, 0-6]; p < 0.001). Global LUS scores remained similar from time 1 to time 2 in both ARDS (19 to 17) and LRTI (8 to 7) groups. There were moderate correlations between LUS scores and oxygen saturation index ( r = 0.67; p < 0.001), peripheral oxygen saturation/F io2 ratio ( r = -0.63; p < 0.001), mean airway pressure ( r = 0.63; p < 0.001), positive end-expiratory pressure ( r = 0.52; p < 0.001), and dynamic compliance ( r = -0.43; p = 0.001). Higher LUS scores were associated with fewer ventilator-free days at 28 days ( p < 0.001), fewer positive pressure ventilation-free days at 28 days ( p < 0.001), and fewer ICU-free days at 28 days ( p < 0.001). CONCLUSIONS: In critically ill children with acute respiratory failure, global LUS scores within 24 hours of admission differed by severity of parenchymal lung disease, correlated with oxygenation parameters, and were associated with patient-centered outcomes of duration of respiratory support and PICU length of stay.

  PublisherDOI

• Comparative Decision-Making Analysis of Extracorporeal Membrane Oxygenation Candidacy Based on a Survey of Pediatric Critical Care Fellow and Attending Physicians

  Journal of ExtraCorporeal Technology · 2026-01-20

  articleOpen accessSenior author

  Background: Extracorporeal membrane oxygenation (ECMO) candidacy decisions for children with respiratory failure can be variable among pediatric critical care attending physicians, and prior studies showed that baseline functional status and underlying neurological conditions influence this decision. However, there are limited data regarding factors influencing pediatric critical care fellows' ECMO candidacy decisions and their alignment with attending physicians. This study aimed to identify patient characteristics influencing fellows' ECMO candidacy decisions and measure concordance with attending decisions. Methods: This study was a planned secondary analysis of a prospective, single-center, cross-sectional study at a quaternary pediatric ECMO referral center. Pediatric critical care fellows and attending physicians caring for children admitted with acute respiratory failure were surveyed within 72 hours of initiation or escalation of respiratory support. The primary exposure was patient functional status at admission, measured by the functional status score (FSS), and was categorized as Normal/Mild Dysfunction (FSS 6-9) or Moderate/Severe Dysfunction (FSS &gt;10). Multivariate logistic regression clustered by fellow evaluated factors influencing ECMO candidacy assessments. Cohen’s kappa measured concordance between fellow and attending decisions. Results: Eighty surveys were completed by 21 pediatric critical care fellows. Fellows identified 19% of patients as ECMO non-candidates. After adjustment for age, moderate/severe admission dysfunction significantly reduced the odds of ECMO candidacy (aOR 0.11, 95% CI 0.03-0.51, p=0.005). Overall, concordance between fellows and attendings was moderate (κ=0.56) with junior fellows having minimal agreement (κ=-0.12). Fellows focused primarily on baseline functional status and comorbidities while attendings considered additional factors, including long-term prognosis, organ failure irreversibility, and ECMO-related risks in candidacy assessments. Conclusion: Admission functional status influences pediatric critical care fellows' ECMO candidacy decisions, with moderate concordance observed between fellows and attending physicians. The identified discrepancies emphasize the importance of structured education and targeted mentorship programs to enhance consistency in ECMO candidacy assessments, especially among junior trainees.

  PublisherOA PDFDOI

• Extracorporeal cardiopulmonary resuscitation for pediatric cardiac arrest: lifesaving rescue, but not for everyone

  Current Opinion in Pediatrics · 2026-02-23

  article

  PURPOSE OF REVIEW: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used as a rescue therapy for pediatric cardiac arrest. Its use has expanded beyond its original application in select cardiac populations at highly specialized centers despite limited evidence regarding patient selection, intra-arrest management, and long-term outcomes. Current pediatric ECPR data are derived predominantly from observational studies and registries that are vulnerable to selection bias and incomplete reporting. Estimates of benefit may be overstated, and generalizability across heterogeneous cardiac arrest populations remains uncertain. RECENT FINDINGS: We examine five key vulnerabilities in pediatric ECPR: limitations of supporting data; challenges in patient selection; compromise of other resuscitative priorities during deployment; impact on patients and families; and strain on healthcare systems and personnel. While ECPR can be lifesaving for carefully selected patients, its indiscriminate application risks unintended harm by undermining patient-centered outcomes and program sustainability. SUMMARY: Responsible expansion of ECPR requires acknowledgement of existing knowledge gaps, investment in thorough collection of prospective data including neurologic and quality-of-life outcomes, and development of clearer institutional frameworks for candidacy. Aligning eagerness for this rescue modality with scientific objectivity is critical to ensure ECPR aligns with the best interests of children, families, and healthcare systems.

  PublisherDOI

• Comparative Decision-Making Analysis of Extracorporeal Membrane Oxygenation Candidacy Based on a Survey of Pediatric Critical Care Fellow and Attending Physicians

  Springer Link (Chiba Institute of Technology) · 2026-01-21

  articleOpen accessSenior author

  Background: Extracorporeal membrane oxygenation (ECMO) candidacy decisions for children with respiratory failure can be variable among pediatric critical care attending physicians, and prior studies showed that baseline functional status and underlying neurological conditions influence this decision. However, there are limited data regarding factors influencing pediatric critical care fellows' ECMO candidacy decisions and their alignment with attending physicians. This study aimed to identify patient characteristics influencing fellows' ECMO candidacy decisions and measure concordance with attending decisions. Methods: This study was a planned secondary analysis of a prospective, single-center, cross-sectional study at a quaternary pediatric ECMO referral center. Pediatric critical care fellows and attending physicians caring for children admitted with acute respiratory failure were surveyed within 72 hours of initiation or escalation of respiratory support. The primary exposure was patient functional status at admission, measured by the functional status score (FSS), and was categorized as Normal/Mild Dysfunction (FSS 6-9) or Moderate/Severe Dysfunction (FSS >10). Multivariate logistic regression clustered by fellow evaluated factors influencing ECMO candidacy assessments. Cohen’s kappa measured concordance between fellow and attending decisions. Results: Eighty surveys were completed by 21 pediatric critical care fellows. Fellows identified 19% of patients as ECMO non-candidates. After adjustment for age, moderate/severe admission dysfunction significantly reduced the odds of ECMO candidacy (aOR 0.11, 95% CI 0.03-0.51, p=0.005). Overall, concordance between fellows and attendings was moderate (κ=0.56) with junior fellows having minimal agreement (κ=-0.12). Fellows focused primarily on baseline functional status and comorbidities while attendings considered additional factors, including long-term prognosis, organ failure irreversibility, and ECMO-related risks in candidacy assessments. Conclusion: Admission functional status influences pediatric critical care fellows' ECMO candidacy decisions, with moderate concordance observed between fellows and attending physicians. The identified discrepancies emphasize the importance of structured education and targeted mentorship programs to enhance consistency in ECMO candidacy assessments, especially among junior trainees.

  OA PDFDOI

• Plasma Biomarkers of Brain Injury in Critically Ill Children Receiving Extracorporeal Membrane Oxygenation

  JAMA Pediatrics · 2026-03-02 · 1 citations

  articleOpen access

  Importance: Timely identification of acute brain injury (ABI) in children receiving extracorporeal membrane oxygenation (ECMO) support is critical for early neuroprotective interventions. Objectives: To determine if elevations in plasma glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and tau levels in children receiving ECMO precede new ABI confirmed by neuroimaging, and if they are associated with mortality and functional outcomes. Design, Setting, and Participants: This was a prospective observational cohort study conducted from 2019 to 2023, with 18-month follow-up completed in 2025. Children aged 2 days to younger than 18 years at ECMO cannulation were recruited from 11 US children's hospitals. Study data were analyzed from May to August 2025. Exposures: GFAP, NfL, and tau measured in plasma samples collected serially during the ECMO course. Main Outcomes and Measures: Unfavorable short-term outcome was a composite of in-hospital mortality or discharge Pediatric Cerebral Performance Category score of 3 or greater with decline of at least 1 point from baseline. Unfavorable long-term outcome was a composite of mortality or Vineland Adaptive Behavior Scales, third edition, composite score less than 85 at 18 months after ECMO. Results: This study included 219 participants (224 ECMO courses; 1089 serial blood samples). Median age was 11 months (IQR, 30 days-9 years), and 121 (54%) were male. Among 60 ECMO courses with new ABI during the ECMO course, GFAP and NfL levels increased significantly, by 6.4% (95% CI, 1.4%-11.6%) and 16.1% (95% CI, 10.5%-22.0%), respectively, for each 24 hours preceding neuroimaging diagnosis of new ABI. Geometric means for GFAP, NfL, and tau were all significantly higher in those with unfavorable vs favorable outcome at hospital discharge for both the first sample receiving ECMO and peak levels during ECMO support. A 2-fold increase in GFAP and NfL levels from first sample receiving ECMO was significantly associated with unfavorable outcome after adjusting for baseline GFAP and NfL levels, age, and ECMO indication (GFAP adjusted hazard ratio [aHR], 1.48; 95% CI, 1.22-1.79; NfL aHR, 1.43; 95% CI, 1.14-1.79). Similar models for tau showed no significant association with outcomes. Conclusions and Relevance: Results suggest that GFAP and NfL may be promising candidates for real-time neurologic monitoring in children receiving ECMO and may aid in diagnosis, association with outcomes, and potentially guiding neuroprotective strategies.

  PublisherOA PDFDOI

• The impact of arterial catheter-to-vessel ratio on distal arterial flow and measured arterial pressures in a pulsatile arterial vessel phantom

  The Journal of Vascular Access · 2025-11-03

  article

  Background: The effect of catheter size on distal arterial flow and measured arterial pressure remains underexplored. This study evaluates the relationship between catheter-to-vessel ratio (CVR), distal arterial flow, and measured blood pressures in a controlled pulsatile arterial vessel phantom. Methods: Using in vitro data simulating arterial conditions, distal peak systolic velocity, systolic (SBP), and diastolic (DBP) were analyzed across varying catheter sizes and vessel diameters. Pearson correlation and linear regression were used to assess the relationship between CVR and changes in relative distal velocity, SBP, and DBP. Results: Relative distal peak systolic velocity exhibited a strong inverse relationship with CVR ( r = −0.903, p &lt; 0.001), with linear regression indicating that for every 10% increase in CVR, distal peak systolic velocity decreased by approximately 9.3%. Flow reduced &gt;20% when CVR exceeded 0.6 and &lt;5% when CVR was below 0.4. SBP demonstrated a strong positive correlation with CVR ( r = 0.88, p &lt; 0.001). SBP increased by approximately 2.8% for every 10% increase in CVR. SBP increased by &gt;10 mmHg when CVR exceeded 0.6 and &lt;5 mmHg when CVR was below 0.4 Relative DBP showed no significant correlation with CVR ( r = 0.13, p = .61). Conclusions: Higher CVR in an in vitro model is associated with reduced distal flow and elevated systolic blood pressure in a phantom model. A CVR &lt;0.4 (40%) appears to minimize flow and pressure changes. Appropriate selection of arterial catheter diameter for patient care may reduce risk of arterial catheter injuries and improve accuracy of clinical data.

  PublisherDOI

• Early exposure to hemodynamic point-of-care ultrasound during pediatric septic shock resuscitation is associated with decreased fluid overload

  Intensive Care Medicine – Paediatric and Neonatal · 2025-09-24

  articleOpen access

  Abstract Objective Fluid overload (FO) after pediatric septic shock resuscitation increases the risk of secondary organ failure and long-term morbidity. We hypothesized that early hemodynamic point-of-care ultrasound (hPOCUS) use in pediatric septic shock would be associated with decreased FO. Methods Retrospective, observational study between 2015 and 2018 in a large academic Pediatric Intensive Care Unit (PICU) of children &lt; 18 years receiving ≥ 40 mL/kg of bolus fluids or vasoactive infusion for treatment of septic shock. %FO and severe FO (%FO ≥ 15%) at 72 h after shock onset were compared between children with hPOCUS exposure &lt; 6 h after shock onset and those without. %FO was calculated: [(fluid in – out)/weight on PICU admission]*100. The association between hPOCUS &lt; 6 h after septic shock onset and %FO and severe FO were evaluated. Results Of 591 children included, 115 (19.4%) had hPOCUS within 6 h. Children with early hPOCUS vs. without had higher PIM-3; median 4.3, IQR 2.9–9.4 vs. 3.2, IQR 0.9–5.7, p = 0.0012. %FO was not significantly different in the early hPOCUS group, median difference -1.6%, 95% CI -3.2 to 0.03, p = 0.06. After controlling for confounders, %FO was significantly lower in the early hPOCUS group, ß-coefficient= -2.76, 95% CI -4.7 to -0.6, p = 0.012. Those with early hPOCUS had lower occurrence of severe FO 11.3% vs. 22.9%, p = 0.006; adjusted OR 0.41, 95% CI 0.22 to 0.76, p = 0.005. Conclusions Early hPOCUS assessment during septic shock resuscitation was independently associated with decreased FO. Prospective research is needed to optimize hPOCUS use in pediatric septic shock management.

  PublisherOA PDFDOI

• 202: METABOLIC PROFILE ASSOCIATED WITH ECMO STATUS AND OUTCOMES IN PEDIATRIC CARDIAC PATIENTS

  Critical Care Medicine · 2025-01-01

  article
  PublisherDOI

• Temporary Femoral Central Venous Catheters in the PICU: Two-Center, Retrospective Cohort Study of Catheter Tip Position and Symptomatic Venous Thromboembolism, 2016–2021

  Pediatric Critical Care Medicine · 2025-02-11 · 2 citations

  articleOpen accessSenior author

  OBJECTIVES: We aimed to determine the frequency and variables associated with low femoral central venous catheter (fCVC) tip position. We also examined the association between tip position and symptomatic venous thromboembolism (VTE). DESIGN: Retrospective cohort from two PICUs. SETTING: Quaternary academic children's hospitals, 2016-2021. PATIENTS: Children (age <18 yr) in the PICU who underwent temporary fCVC placement. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Low fCVC tip position occurs when the tip is inferior to the fifth lumbar vertebra (L5) on a postprocedural abdominal radiograph. Of 936 patients: 56.3% were 1-12 years old, and 80.0% had normal weight-for-age z score. fCVC tip position was low in 67.3% of patients. In the multivariable model, older age, earlier years of placement, and higher weight-for-age were associated with low fCVC tip position. Symptomatic fCVC-associated VTE occurred in 8.8% of patients, with a rate of 16.5 per 1000 CVC days (interquartile range, 13.1-20.5 per 1000 CVC days). The percentage of VTE in low vs. recommended fCVC tip position and VTE (8.6% vs. 9.2%) were equivalent (two one-sided z-tests; p < 0.001). Furthermore, in the multivariable model, we failed to identify an association between low fCVC tip position, relative to the recommended tip position, and greater odds of VTE (OR, 1.58 [95% CI, 0.92-2.69). However, we cannot exclude the possibility of low fCVC tip position being associated with up to 2.6-fold greater odds of symptomatic VTE. CONCLUSIONS: In our two PICUs, 2016-2021, low fCVC tip position occurred in two-thirds of placements and was associated with older age and higher weight-for-age patients. fCVC-associated VTE occurred in one-in-11-catheter placements, with the raw percentage of fCVCs and subsequent VTE in low and recommended tip position being equivalent. However, the multivariable modeling indicates that future research into the relationship between tip position and VTE requires ongoing surveillance and work.

  PublisherOA PDFDOI

• Right Atrial Dysfunction Is Prevalent in Pediatric Acute Respiratory Distress Syndrome and Reflects Pulmonary Hypertension and Right Ventricular Dysfunction

  Critical Care Explorations · 2025-03-01 · 1 citations

  articleOpen accessSenior author

  IMPORTANCE: Right atrial (RA) dysfunction is associated with worse outcomes in some populations with pulmonary hypertension or respiratory failure but the prevalence and correlates of RA dysfunction in pediatric acute respiratory distress syndrome (PARDS) are unknown. OBJECTIVES: The aim of this study was to evaluate RA function by characterizing the prevalence and pattern of RA dysfunction within the first 24 hours of PARDS onset. We hypothesized that RA dysfunction would be common and correlate with the presence of pulmonary hypertension and right ventricular (RV) systolic dysfunction. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, single-center cohort study at a tertiary care PICU of children (< 18 yr) with a clinically obtained echocardiogram within 24 hours following PARDS diagnosis and healthy controls without cardiopulmonary disease. MAIN OUTCOMES AND MEASURES: Echocardiograms were evaluated for conventional and speckle-tracking (or strain) echocardiographic measures of RA and RV systolic function. Nonparametric summary statistics, comparisons, and correlational analyses were completed. RESULTS: Ninety-two PARDS patients and 55 controls were included. Using a priori thresholds (> 2 sds of control values), 49% (n = 45) of PARDS patients demonstrated RA dysfunction in at least one RA functional metric. The maximal RA strain during the reservoir phase was reduced in PARDS compared with controls (median 40.2% vs. 53.7%; p < 0.001). Patients with echocardiographic evidence of pulmonary hypertension had lower maximal RA strain during the reservoir phase (31.7%) compared with patients without (40.5%; p < 0.05). Patients with higher brain-type natriuretic peptide plasma concentrations had worse RA function. RA function significantly correlated with conventional and strain measures of RV systolic function. CONCLUSIONS AND RELEVANCE: RA dysfunction is common within the first 24 hours of PARDS onset. RA dysfunction during the reservoir phase is associated with pulmonary hypertension and RV systolic dysfunction. Future studies investigating trajectories of RA function and their association with outcomes in PARDS patients are needed.

  PublisherDOI

Recent grants

• The Roles of Pulmonary Hypertension and Right Ventricular Dysfunction in Pediatric Acute Respiratory Distress Syndrome

  NIH · $879k · 2021–2026

Frequent coauthors

• Thomas Conlon

  Children's Hospital of Philadelphia

  78 shared

• Robert A. Berg

  University of Pennsylvania

  72 shared

• Akira Nishisaki

  University of Pennsylvania

  67 shared

• Nadir Yehya

  Children's Hospital of Philadelphia

  65 shared

• Todd J. Kilbaugh

  Children's Hospital of Philadelphia

  55 shared

• Christie Glau

  University of Pennsylvania

  50 shared

• Ryan W. Morgan

  University of Pennsylvania

  44 shared

• Vinay Nadkarni

  Children's Hospital of Philadelphia

  34 shared

Education

• B.A., Biological Sciences

  University of Delaware

  2000

• B.S., Biochemistry

  University of Delaware

  2001

• M.D.

  University of Pittsburgh School of Medicine

  2005

• Other

  Perelman School of Medicine at the University of Pennsylvania

  2022