Postoperative Extracorporeal Life Support in Pediatric Cardiac Surgery: Recent Results

Abstract

We retrospectively reviewed the files of 19 extracorporeal life support (ECLS) applications performed after cardiac surgery in 15 patients from January 2002 to December 2004. We placed 16 arteriovenous ECLS applications with oxygenator, 2 venovenous ECLS applications with oxygenator, and 1 biventricular ECLS application without oxygenator (graft dysfunction after heart transplant). Mean age was 4.9 +/- 7 years (median 5.9 months, range 11 days to 21 years). All patients underwent surgery for congenital heart disease, except for one patient who had a heart transplant. Indications were hemodynamic failure in 12 cases, respiratory failure in 5 cases, and mixed failure in 2 cases. Four patients were undergoing cardiopulmonary resuscitation during ECLS placement (no deaths). Mean delay between surgery and ECLS placement was 3.2 +/- 3.4 days (median 2 days). Mean ECLS duration was 3.4 +/- 5.8 days (mean 6 days, range 3-16 days). Three patients had further surgery for residual lesions. Thirteen patients (86.7%) survived to ECLS weaning; 12 patients survived to hospital discharge (80%). No survivor presented obvious neurologic damage. Specific morbidity included reentry for bleeding, multiple transfusions, and mediastinitis. These results support early placement of ECLS in children whenever a severe postoperative hemodynamic or respiratory failure, refractory to medical treatment, is present.

Part 12: Cardiac Arrest in Special Situations

“…Nine case series have reported survival of some post-cardiac surgery patients during cardiac arrest refractory to standard resuscitation measures following the use of extracorporeal membrane oxygenation [537][538][539][540][541] and cardiopulmonary bypass. 529,[542][543][544] In post-cardiac surgery patients who are refractory to standard resuscitation procedures, mechanical circulatory support (eg, extracorporeal membrane oxygenation and cardiopulmonary bypass) may be effective in improving outcome (Class IIb, LOE B).…”

Part 8: Advanced Life Support

“…Three studies reported equivocal findings (LOE 5). [701][702][703] No studies opposed use of mechanical circulatory support. Mechanical circulatory support devices in these studies included extra-corporeal membrane oxygenation or cardiopulmonary bypass.…”

Minimizing bleeding associated with mechanical circulatory support following pediatric heart surgery☆

“…Since its inception, ECMO has been used to provide mechanical cardiopulmonary support to more than 6000 pediatric patients in the postoperative period, according to the ELSO Registry. Several centers have reported that approximately 2-4% of neonatal and pediatric patients undergoing surgical correction require postcardiotomy ECLS [1,3,[16][17][18], with rates as high as 6-7% being reported in centers that care for high-risk neonates [2,16]. The frequency with which ECLS is used is dependent upon the complexity of the operation, experience of the surgeon and other members of the medical team, availability of ECLS equipment, and the programmatic philosophy toward postoperative ECLS.…”

“…In addition to requiring increasing pharmacologic and mechanical ventilatory support, up to 6.8% of these patients may require extracorporeal cardiopulmonary support to improve oxygen delivery and facilitate myocardial recovery [1][2][3]. However, the use of extracorporeal life support (ECLS) immediately following open cardiac surgical repair is complicated by surgical-site bleeding in approximately one-third of patients (2008 Extracorporeal Life Support Organization (ELSO) Registry; available at: http://www.elso.med.umich.edu).…”