Extracorporeal membrane oxygenation following pediatric cardiac surgery: development and outcomes from a single-center experience

Abstract

Extracorporeal membrane oxygenation (ECMO) has emerged as an effective mechanical support following cardiac surgery with respiratory and cardiac failure. However, there are no clear indications for ECMO use after pediatric cardiac surgery. We retrospectively reviewed medical records of 76 pediatric patients [mean age, 10.8 months (0–86); mean weight, 5.16 kg (1.16–16.5)] with congenital heart disease who received ECMO following cardiac surgery between January 1997 and October 2010. Forty-five patients were treated with an aggressive ECMO approach (aggressive ECMO group, April 2005–October 2010) and 31 with a delayed ECMO approach (delayed ECMO group, January 1997–March 2005). Demographics, diagnosis, operative variables, ECMO indication, and duration of survivors and non-survivors were compared. Thirty-four patients (75.5%) were successfully weaned from ECMO in the aggressive ECMO group and 26 (57.7%) were discharged. Conversely, eight patients (25.8%) were successfully weaned from ECMO in the delayed ECMO group and two (6.5%) were discharged. Forty-five patients with shunted single ventricle physiology (aggressive: 29 patients, delayed: 16 patients) received ECMO, but only 15 (33.3%) survived and were discharged. The survival rate of the aggressive ECMO group was significantly better when compared with the delayed ECMO group (p<0.01). Also, ECMO duration was significantly shorter among the aggressive ECMO group survivors (96.5 ± 62.9 h, p<0.01). Thus, the aggressive ECMO approach is a superior strategy compared to the delayed ECMO approach in pediatric cardiac patients. The aggressive ECMO approach improved our outcomes of neonatal and pediatric ECMO.

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

“…ECLS allows transportation of patients in cardiopulmonary collapse and bridging of critically ill patients to be recovered. There have been no agreed criteria that can be used to predict the need for ECLS support in the perioperative/postoperative period and mostly clinical judgment is defined as what we rely on, when evaluating potential patients (8,9). However, Belohlavek et al reported increased mortality rate during ECLS run in the patients with higher Sequential Organ Failure Assessment score (10).…”

Clinical Management of the Extracorporeal Membrane Oxygenation Circuit

“…Early use of mechanical support may reverse the progression of organ failure and lead to shorter duration of ECMO and increased patient survival (2). The definition of maximal treatment varies in these circumstances but includes adequate circulating blood volume, adequate hemoglobin, and a large amount of inotropic drugs.…”

Effect of the Pulsatile Extracorporeal Membrane Oxygenation on Hemodynamic Energy and Systemic Microcirculation in a Piglet Model of Acute Cardiac Failure

“…Mechanical circulatory support systems have successfully improved clinical outcomes in patients with cardiac and respiratory dysfunctions (1). Extracorporeal membrane oxygenation (ECMO) is widely used for respiratory and circulatory support, especially in critical cases such as acute cardiac dysfunction, cardiac resuscitation, and acute respiratory distress syndrome (2)(3)(4).…”