Extracorporeal Membrane Oxygenation Circulatory Support After Congenital Cardiac Surgery

Suzuki, Yasuyuki; Yamauchi, Sanae; Daitoku, Kazuyuki; Fukui, Kozo; Fukuda, Ikue

doi:10.1097/mat.0b013e31818f0056

Cited by 11 publications

(10 citation statements)

References 20 publications

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“…In our study, both arterial pH values and lactate levels at ECLS initiation were found statistically significantly lower in those who successfully weaned from ECLS. ECLS is rarely required after congenital heart surgery, with the need varying from 1 to 3.5% of all congenital cardiac surgery cases . In our study, ECLS use after the surgery was 2%.…”

Section: Discussionmentioning

confidence: 54%

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

et al. 2013

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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.

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Section: Discussionmentioning

confidence: 54%

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

et al. 2013

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“…Patients on ECMO require systemic anticoagulation to prevent the coagulopathic process initiated when blood contacts an artificial surface, but this therapy predisposes patients on ECMO to life-threatening hemorrhage (1–3). The frequency of children with complex congenital heart disease or cardiomyopathies requiring ECMO has increased steadily over the past decade (4, 5), and those placed on ECMO after cardiac surgery already have disturbed coagulation pathways and additional surgical sites, factors that have been hypothesized to confer a greater propensity toward bleeding than other ECMO populations (6). Severe bleeding can make ongoing support impossible and may contribute directly to perioperative mortality (7).…”

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confidence: 99%

Hemorrhagic Complications in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation

Werho

Pasquali

et al. 2015

Pediatric Critical Care Medicine

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Objectives To determine the prevalence of and risk factors for hemorrhagic complications in children with cardiac disease requiring extracorporeal membrane oxygenation. Design Retrospective review of the Extracorporeal Life Support Organization Registry (2002–2013). Setting Participating Extracorporeal Life Support Organization centers. Patients Patients less than 18 years old on extracorporeal membrane oxygenation. Interventions None. Measurements and Main Results Of 21,845 patients requiring extracorporeal membrane oxygenation during the study period, 8,905 (41%) had cardiac disease, and 79% of whom (6,995) had cardiac surgery. Hemorrhagic complications occurred in 8,480 patients (39% of overall cohort), with higher rates in cardiac versus noncardiac patients (49% vs 32%; p < 0.0001) related to cannulation and surgical site bleeding. Cardiac surgical patients had higher rates of hemorrhage compared with cardiac medical patients (57% vs 38%; p < 0.0001), and cardiac patients with hemorrhage had higher extracorporeal membrane oxygenation mortality compared with those without (42% vs 22% in medical patients and 34% vs 20% in surgical patients; both p < 0.0001). In multivariable analysis in both the cardiac medical and surgical groups, hemorrhage risk was higher in children greater than 1 year old and in patients with longer extracorporeal membrane oxygenation duration. Additional independent risk factors for hemorrhage in cardiac surgical patients included pre-extracorporeal membrane oxygenation mediastinal exploration (odds ratio, 3.6; 95% CI, 2.1–6.3), Society of Thoracic Surgeons morbidity category 4–5 (odds ratio, 1.2; 95% CI, 1.03–1.5), cannulation less than 24 hours after surgery (odds ratio, 1.6; 95% CI, 1.3–1.9), and longer cardiopulmonary bypass time (≥ 282 min [upper quartile]; odds ratio, 1.5; 95% CI, 1.3–1.9). Conclusions In this large, multicenter analysis, hemorrhagic complications occurred in nearly half of children with heart disease on extracorporeal membrane oxygenation and were associated with a significant mortality risk. Several factors were associated with hemorrhagic complications in cardiac surgical patients including pre-extracorporeal membrane oxygenation mediastinal exploration, greater surgical complexity, early postoperative cannulation, and longer bypass times. Whether these risks can be mitigated by modifying or delaying systemic anticoagulation requires further investigation.

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“…All patients who underwent additional operative procedure except case no. 10 were previously reported with details about the clinical course (9). Case no.…”

Section: Resultsmentioning

confidence: 99%

The Impact of Extracorporeal Membrane Oxygenation on Survival in Pediatric Patients With Respiratory and Heart Failure: Review of Our Experience

Goto

Suzuki

et al. 2011

Artificial Organs

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Extracorporeal membrane oxygenation (ECMO) is widely used for circulatory support in pediatric cardiac patients with low cardiac output and hypoxemia. We retrospectively evaluated the efficacy of ECMO support for respiratory and heart failure in infants and children. From April 2002 to February 2011, 14 patients aged 19 days to 20 years old (average 44 months), with body weight 2.6 kg to 71 kg (median 14.1 kg), underwent ECMO support for failing cardiac function, hypoxemia, and low cardiac output syndrome. In 12 patients, ECMO was introduced after operation for congenital heart disease (four with complete repair including Fontan circulation, and eight with palliative repair). In one patient, ECMO was introduced after partial pulmonary resection for congenital cystic adenomatoid malformation because of respiratory failure. ECMO was introduced in a patient with severe heart failure caused by fulminant myocarditis. Patients' demographics, duration of extracorporeal membrane oxygenation, additional support, and outcomes were analyzed. Ten patients (71%) were successfully weaned from ECMO, and eight patients (57%) were discharged from the hospital. The mean duration of ECMO support was 332 h (range 11-2030 h). Although management of the ECMO circuit, including anticoagulation (activated clotting time: 150-250), was conducted following the institutional practice guidelines, it was difficult to control the bleeding. Seven patients required renal replacement therapy during ECMO support using peritoneal dialysis or continuous hemodiafiltration. Five patients had additional operative procedures: systemic-pulmonary shunt in two, bidirectional Glenn takedown with right modified Blalock-Taussig shunt, total cavopulmonary connection takedown, and redo ECMO in one patient each. The patient who had the longest ECMO support for respiratory failure due to acute respiratory distress syndrome after lung surgery was successfully weaned from ECMO because high-frequency oscillation (HFO) improved respiratory function. ECMO for heart and respiratory failure in infants and children is effective and allows time for recovery of cardiac dysfunction and acute hypoxic insult. The long-term ECMO support for over 2000 h was very rare, but it was possible to wean this patient from ECMO using HFO.

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Extracorporeal Membrane Oxygenation Circulatory Support After Congenital Cardiac Surgery

Cited by 11 publications

References 20 publications

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

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

Hemorrhagic Complications in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation

The Impact of Extracorporeal Membrane Oxygenation on Survival in Pediatric Patients With Respiratory and Heart Failure: Review of Our Experience

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