Extracorporeal Life Support Registry Report 2008: Neonatal and Pediatric Cardiac Cases

Abstract

Each year thousands of patients require extracorporeal life support (ECLS) for a variety of respiratory, cardiac, and emergency reasons. The ECLS registry, a Federal Drug Administration approved control group, provides a database of approximately 37,000 ECLS patients from domestic and international hospitals, with details about demographic factors, diagnosis, treatment, and complications. The report is circulated to Extracorporeal Life Support Organization members with the goal of providing feedback on each center's practices relative to the performance of all of the centers, and to the general public with the goal of enhancing research and improving patient care. In this report, the ECLS Registry Report International Summary for July 2008 is analyzed with a specific focus on neonatal and pediatric cardiac patients. From the data, it is evident that cardiac ECLS patients have a lower chance of survival than respiratory ECLS patients, and furthermore, younger patients have a lower chance of survival. Requirement for inotropes while on ECLS is by far the most common complication, followed by surgical site bleeding, necessitating hemofiltration. The major mechanical complications facing cardiac ECLS patients are oxygenator failure and clots in the circuit. Databases such as this one provide powerful tools for institutions, clinicians, and researchers.

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…493 According to the Extracorporeal Life Support Organization registry, cardiac ECMO was used in >600 patients in 2006 and 2007; more than half the patients were <30 days of age. 494 In this youngest age group, survival was 35% to 40%. In older patients, survival was better, 47% to 49% in patients 31 days to 1 year of age and 58% to 59% December 17, 2013 in patients 1 to 16 years of age, and is consistent with large single-center experiences.…”

“…497 In the most recent report from the Extracorporeal Life Support Organization registry, thrombotic, thromboembolic, and bleeding complications were identified frequently, and the youngest patients were at the greatest risk. 494 It has been generally accepted that for patients on ECMO, a lower level of anticoagulation is necessary compared with patients undergoing surgery using CPB, but a recent study suggested improved survival for patients on ECMO with higher heparin doses. 498 The typical anticoagulation protocol includes a loading dose of 100 U/kg heparin before ECMO cannulation and a continuous infusion of heparin to maintain the ACT between 180 and 220 seconds.…”

“…In older patients, survival was better, 47% to 49% in patients 31 days to 1 year of age and 58% to 59% December 17, 2013 in patients 1 to 16 years of age, and is consistent with large single-center experiences. 494,495 Like CPB, ECMO exposes the blood to a large surface area of foreign material and would result in thrombus formation if not for the use of anticoagulation. Bleeding complications are common, and despite anticoagulation, thrombotic and thromboembolic complications are also common on ECMO.…”

2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care (Endorsed by the American heart assocation, the cardiological society of India, and sociedad latino Americana de cardiologia intervencion; Affirmation of value by the canadian association of interventional cardiology–association canadienne de cardiologie d'intervention)

“…As a bridge to definitive therapy, ECMO has also been used in patients with cardiogenic shock from acute coronary syndromes and as a bridge to transplant with or without the use of other ventricular assist devices. Multiple reports of ECMO being instituted for cardiac arrest [102,103] exist, and the institution of ECMO for cardiovascular collapse and cardiac arrest is rapidly growing in popularity [104]. A major advantage is the relative ease of implementation, but a disadvantage is the need for specialized perfusion expertise and nursing.…”

Ventricular Assist Devices for Pediatric Heart Disease

“…Until 2005, more than 30.000 patients, with the support of ECMO, have survived with 65 % success rate (ECLS Registry, 2005). ECLS registry in 2008 provides a database of 37.000 patients from all around the world with details about demographic factors, diagnosis, treatment and complications (Haines et al, 2009). There have been studies with 80 % success for the usage of ECMO on infants with acute hypoxemic respiratory failure (Field et al, 1996).…”