Extracorporeal membrane oxygenation support of the Fontan and bidirectional Glenn circulations

Booth, Karen; Roth, Stephen J.; Thiagarajan, Ravi R.; Almodovar, Melvin C.; Nido, Pedro J. del; Laussen, Peter C.

doi:10.1016/j.athoracsur.2003.09.042

Cited by 126 publications

(99 citation statements)

References 20 publications

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“…5,7,15,16 Fontan failure requiring takedown or need for mechanical support with ECMO is also rare in the current surgical era. 4,8,17 Risk factors for early failure as described by Gentles et al include preoperative mean pulmonary artery pressure, younger age, heterotaxy syndrome, right-sided tricuspid valve as the only systemic AVV, pulmonary artery distortion, nonfenestration, and longer bypass time. Other authors have described common AV valve anatomic variants, 4,5 right ventricular morphology, 18 younger age, high postoperative right atrial pressure, longer bypass and aortic cross clamp times, and preoperative palliation to be risk factors for Fontan failure.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Prolonged Recovery After the Fontan Operation

et al. 2008

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Background-Mortality and major morbidity after the Fontan operation is low in the current era. However, factors contributing to prolonged postoperative recovery are not clearly understood. Methods and Results-Data on all patients admitted to the cardiac intensive care unit (CICU) after a Fontan operation between June 2001 and December 2005 were retrospectively analyzed. We excluded all patients who died, required Fontan takedown, or required ECMO. The study cohort was further divided into a prolonged recovery group that included patients with Ͼ75%ile for duration of mechanical ventilation or pleural drainage, and a standard recovery group which included all other patients. A multivariable logistic regression model was used to compare demographic, anatomic, and physiological variables between the prolonged and standard recovery groups. There were 226 Fontan operations performed. Of the study population (nϭ218), the median age was 2.61 years (1.0 to 31.9 years) and weight was 12.45 kg (8.4 to 77.5 kg). The most common diagnosis was hypoplastic left heart syndrome (nϭ80, 36.7%). A systemic right atrioventricular valve was present in 139 (63.7%). The lateral tunnel fenestrated Fontan was the most common surgery (nϭ195, 89.4%). Within the study population, 81 (38%) patients meet criteria for prolonged recovery. Univariate risk factors for prolonged recovery included higher preoperative PVR (Pϭ0.033), longer bypass times (Pϭ0.009), higher postbypass lactate level (Pϭ0.017), higher postoperative central venous (PϽ0.001) common atrial pressure (Pϭ0.042), inotropic score (PϽ0.001), and need for greater volume resuscitation during the 24 postoperative hours (Ͼ75% for the entire group; PϽ0.001). In a multivariable model, need for greater volume resuscitation (OR 2.81, 95% CI 1.30, 6.05) was the only independent risk factor for prolonged outcome after the Fontan operation. Conclusions-High volume expansion in the early postoperative period is an independent risk factor for prolonged recovery. The need for high volume expansion may represent the compound effects of multiple risk factors including preoperative hemodynamics and a marked systemic inflammatory response to surgery and cardiopulmonary bypass, which in turn may mediate prolonged recovery. (Circulation. 2008;118[suppl 1]:S171-S176.)

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Prolonged Recovery After the Fontan Operation

et al. 2008

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“…362,363 During cardiopulmonary arrest, it is reasonable to consider extracorporeal membrane oxygenation (ECMO) for patients with Fontan physiology (Class IIa, LOE C). 364 It is unclear at this time whether patients with hemi-Fontan/BDG physiology in cardiac arrest might benefit from ECMO.…”

Section: Traumamentioning

confidence: 99%

Part 14: Pediatric Advanced Life Support

Kleinman¹,

Chameides²,

Schexnayder³

et al. 2010

Circulation

913

308

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“…2 The ELSO registry reported that rates of survival to weaning from ECMO and survival to hospital discharge were 59% and 39% in neonatal patients, and 62% and 46% in pediatric patients, respectively. 3 In our study, rates of survival to weaning from ECMO and survival to hospital discharge were 75.5% and 57.7%, respectively.…”

Section: Booth Et Al Demonstrated That the Survival Of Cardiac Patiementioning

confidence: 99%

“…In 1976, Bartlett et al 1 reported the successful use of ECMO for a neonatal patient with respiratory failure, and ECMO has since been used effectively for a variety of indications including preoperative hemodynamic support, low cardiac output after cardiopulmonary bypass (CPB), sudden cardiac arrest, and as a bridge to heart transplantation. 2 The Extracorporeal Life Support Organization (ELSO) registry reports that the rates of survival off ECMO and survival to discharge among neonatal cardiac patients are 59% and 39%, respectively; in pediatric patients, these values are 62% and 46%, respectively. The rates of survival off ECMO and to discharge among neonates subject to extracorporeal cardiopulmonary resuscitation are 63% and 37%, and in pediatric patients these rates are 52% and 38%, respectively.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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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.

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Extracorporeal membrane oxygenation support of the Fontan and bidirectional Glenn circulations

Cited by 126 publications

References 20 publications

Factors Associated With Prolonged Recovery After the Fontan Operation

Factors Associated With Prolonged Recovery After the Fontan Operation

Part 14: Pediatric Advanced Life Support

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

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