Pediatric patients requiring extracorporeal membrane oxygenation in heart failure: 30‐day outcomes; mid‐ and long‐term survival. A single center experience

Abstract

Nowadays, an increasing number of neonatal and pediatric patients with severe heart failure benefits from extracorporeal membrane oxygenation (ECMO) support. A total of 39 pediatric patients needed venoarterial ECMO (vaECMO) support in our department between January 2008 and December 2016. Patients were retrospectively divided in two groups: 30-day survivor group (17 patients) and 30-day nonsurvivor group (22 patients). Outcome and factors predictive for 30-day mortality and mid-as well as long-term survival up to 7-year follow-up were analyzed by univariate analysis and Kaplan-Meier survival estimation. Basic demographics andpreoperative characteristics did not differ between groups (P > 0.05). 67% of patients were successfully weaned off ECMO and 44% survived 30-day after ECMO application. After 7-year follow-up 28% of pediatric patients were alive. Thirtyday survivors were significantly more likely to undergo elective cardiac surgery (P = 0.001), whereas significantly more 30-day nonsurvivors underwent urgent surgery (P = 0.004). Odds of incidence of catecholamine refractory circulatory failure, failed myocardial recovery, and cerebral edema was significantly higher in 30-day nonsurvivor group (41.6-fold, 16-fold, and 2.5-fold, respectively). Kaplan-Meier survival estimation analysis revealed significant differences in terms of mid-and long-term survival among neonates, infants, toddlers, and preadolescents (Breslow P = 0.037 and Log-Rank P = 0.028, respectively). vaECMO provides an efficient therapy option for life-threatening heart disorders in neonates and pediatric patients being at high risk for myocardial failure leading to circulatory arrest. Urgency of surgery effected on higher mortality, but there was no difference in terms of mortality in 30-day survivor group in comparison to 30-day nonsurvivor group among neonates, infants, toddlers, and preadolescents. K E Y W O R D S30-day outcome, congenital cardiac surgery, extracorporeal membrane oxygenation, heart failure, pediatric and neonatal patients, resuscitation

Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients

“…Tissue microdialysis was not conducted due to its invasiveness and costs. Main characteristics, criteria and technique of vaECMO assistance in neonatal and pediatric patients have been published in detail in previous studies [7][8][9][10][11]. Target activated clotting time was 160-180 s, whereas activated partial thromboplastin time (aPTT) was maintained by 60-80 s., based on daily controls if there was no active bleeding tendency.…”

Artificial Organs 2019: A year in review

“…Julia Merkle et al of the University Hospital of Cologne, Cologne, Germany reported on the use of ECMO in 39 pediatric patients with heart failure and 30‐day outcomes and mid‐ and long‐term survival. After 7‐years 28% of pediatric patients were alive.…”

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

“…Although medical management and equipment have greatly improved, mortality of children with congenital heart disease (CHD) who receive postcardiotomy VA‐ECMO support remains high. The survival rates vary from 1/3 to 2/3 in different hospitals 1‐4 . Diverse complications during ECMO, such as bleeding and thrombosis, 5 acute kidney injury (AKI), 6 and nosocomial infection 7 are linked with significant adverse effects on prognosis.…”