Outcomes and factors associated with early mortality in pediatric postcardiotomy veno‐arterial extracorporeal membrane oxygenation

Abstract

Mortality and morbidity of children received veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) support after cardiac surgery remain high despite remarkable advances in medical management and devices. The purpose of this study was to describe outcomes and risk factors of applying VA‐ECMO in the surgical pediatric population. We retrospectively analyzed 85 consecutive pediatric patients (aged <18 years) who received postcardiotomy VA‐ECMO from January 2010 to December 2018. Median (IQR) age at ECMO implantation in this cohort was 12.7 (6.4, 43.2) months, median weight was 8.5 (6.0, 12.8) kg, mean ECMO duration was 143.2 ± 81.6 hours and mean hospital length of stay was 48.4 ± 32.4 days. Seventy‐five patients (88.2%) were indicated for postcardiotomy cardiogenic shock. The successful ECMO weaning rate was 70.6% and in‐hospital mortality was 52.9%. The most common diagnosis was transposition of great arteries (n = 18, 21.2%), while acute kidney injury occurred most often (n = 64, 75.3%). Multivariate logistic regression analysis showed that thrombocytopenia, hemolysis, and nosocomial infection were positively correlated with in‐hospital mortality. Multivariate Cox proportional hazard regression analysis presented that thrombocytopenia significantly increased the 180‐day mortality in patients with successful weaning. Therefore, multiple factors had adverse effects on prognosis. Patient selection and procedures from ECMO implantation to weaning need to be closely monitored and performed in a timely manner to improve outcome.

Mortality prediction in pediatric postcardiotomy veno-arterial extracorporeal membrane oxygenation: A comparison of scoring systems

“…Patients in our center received VA-ECMO support for the following indications: (a) Cardiac support: failure to wean from cardiopulmonary bypass (CPB); low cardiac output syndrome (LCOS); (b) ECPR; and (c) Respiratory support ( 19 ).…”

“…Routine bedside transthoracic echocardiography and chest X-rays were performed daily, while computed tomography (CT), and magnetic resonance imaging (MRI) were employed according to patient condition and the doctor's judgment. Other detailed approaches to managing pediatric postcardiotomy VA-ECMO have been previously described in literature ( 19 ).…”

Hemostatic complications and systemic heparinization in pediatric post-cardiotomy veno-arterial extracorporeal membrane oxygenation failed to wean from cardiopulmonary bypass

“…Hemostatic complications are classified as major bleeding, circuit change, hemolysis, and thrombocytopenia. Major bleeding included re-exploration due to surgical site or cannula site bleeding, gastrointestinal bleeding, pulmonary hemorrhage, and intracranial hemorrhage (13,14). Hemolysis was captured when plasma-free hemoglobin (pFHb) levels greater than 50 mg/dL were detected.…”

“…Data from all patients were evaluated according to two scientific scores. First, the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) (14).…”

“…The ECMO circuit was replaced if there was evidence of clots in the circuit, including excessive hemolysis (pFHb >100 mg/dL), increased oxygenator delta pressure, reduced oxygen or carbon dioxide transfer from the oxygenator, or consumptive coagulopathy that required repeated transfusion of PLT and FFP. Other detailed approaches to the management of pediatric post-cardiotomy VA-ECMO have been previously described in literature (14).…”