Extracorporeal Life Support Experiences of a New Congenital Heart Center in Turkey

Abstract

Extracorporeal life support (ECLS) provides mechanical support following cardiac surgery when respiratory and cardiac failure occurs. We retrospectively reviewed medical records of patients who needed ECLS at a new congenital heart center in Turkey. Between December 2009 and February 2012, 616 congenital heart operations were performed. A total of 13 patients (seven female) underwent ECLS. The ages of the patients ranged between 16 days and 33 years. There were two neonatal, seven infant, three pediatric, and one adult congenital cases. Medos DPII ECLS system was used in all patients. Mean duration of ECLS was 6.2 ± 5.8 days (ranged from 29 h to 24 days). While central vascular access with aorta and right atrial cannulation was used in 11 patients, neck vessels were used in the other patients. Four patients (30.7%) weaned successfully from ECLS (two infant, two pediatric cases). Three of them had ECLS intraoperatively. In all patients, two (15.4%) were discharged from the hospital. One of them had mild neurologic deficit. Bleeding from the surgical and cannulation sites was the most common complication. Thrombus was detected in pump head and changed uneventfully in three patients. Arterial pH and lactate levels at the beginning of ECLS were significantly lower in patients who were successfully weaned from ECLS than nonsurvivors (P = 0.04 and P = 0.02, respectively). ECLS can be a lifesaving modality in the perioperative period. It may be more beneficial if ECLS is used before the development of severe acidosis and high lactate levels.

Initial Clinical Experiences With Novel Diagonal ECLS System in Pediatric Cardiac Patients

“…Similar to the recent report about the DP3 system, the immediate correction of hypovolemia, surgical revision, or the adequate positioning of the cannula might have solved these problems . Similar to the findings of previous reports, higher lactate levels ( P = 0.009) and longer time required for normalization ( P < 0.001) were both linked to failure to wean off ECLS support and, hence, to hospital deaths . The median immediate lactate level was 8 (range: 2–19) mmol/L in non‐survivors and 4.6 (range: 1.4–16.2) mmol/L in survivors ( P = 0.698), while the median 12th hour lactate level was 7.2 (range: 2.6–17.8) mmol/L in non‐survivors and 4.1 (range: 0.8–20) mmol/L in survivors ( P = 0.51).…”

Extracorporeal membrane oxygenation support after pediatric cardiac surgery: our single-center experience

“…The incidence of cardiac ECMO after congenital heart surgery ranges between 2% and 5%. [1,2,[10][11][12] Similarly, the incidence of ECMO after surgery was 2.3% in our study.…”

“…Currently, indications for use of ECMO in pediatric population have been expanded, including circulatory support before congenital cardiac surgery, [13] severe myocardial dysfunction and myocarditis as a bridge to recovery, [14,15] or as bridge to transplantation, [14][15][16] treatment of pulmonary hypertension, [17] circulatory support after congenital cardiac surgery, [1,2,[10][11][12] and after transplantation. [18] Extracorporeal membrane oxygenation indications for postcardiotomy circulatory support in pediatric cardiac surgery cases are affected by many factors such as ventricular function, response to conventional inotropic support, and pulmonary artery pressure.…”

Clinical Experience Receiving ECMO for Acute Respiratory Distress Syndrome

“…Türkiye'de VA ECMO, erişkin ve pediatrik kalp cerrahi merkezlerinde ve bazı pediatrik yoğun bakım ünitelerinde yaygın olarak kullanılmaktadır (16)(17). VV ve VA ECMO'nun, dahili yoğun bakım ünitelerinde ARDS'li hastalarda kullanımı nispeten yenidir (18).…”