Prognostic Risk Analyses for Postcardiotomy Extracorporeal Membrane Oxygenation in Children: A Review of Early and Intermediate Outcomes

Abstract

We evaluated the morbidity and mortality of children requiring postcardiotomy extracorporeal membrane oxygenation (ECMO) to determine independent factors affecting early and intermediate outcomes. Between January 2002 and December 2015, 79 instances of ECMO after cardiac surgery in 73 children were retrospectively reviewed. Follow-up was completed in December 2016. Predictive risk analyses were employed concerning weaning of ECMO, hospital discharge, and mortality after discharge. Age and weight were 14.9 ± 25.6 months and 7.0 ± 5.3 kg, respectively. Median support time was 8.3 ± 4.4 days. Sixty-seven (85%) were successfully weaned off ECMO and 48 (61%) survived to hospital discharge. Multi-variate logistic regression analysis identified the first day to obtain negative fluid balance after initiation of support (adjusted odds ratio = 0.42), high serum lactate levels (0.97), and high total bilirubin (0.84) during support as significant independent factors associated with successful separation from ECMO. The first day of negative fluid balance (0.65) after successful decannulation was an independent risk factor for survival to hospital discharge. After hospital discharge, actuarial 1-year, 5-year, and 10-year survival rates were 94%, 78%, and 78%, respectively. Low weight increased the risk of death after hospital discharge by a multi-variate Cox hazard model. High serum lactate, high serum bilirubin, and unable to obtain early negative fluid balance during support impacted mortality of decannulation. Obtaining a late negative fluid balance in post-ECMO were independent risk factors for death after successful weaning. Low weight affected intermediate outcomes.

Use of extracorporeal membrane oxygenation in postcardiotomy pediatric patients: parameters affecting survival

“…In pediatric cardiac patients, mechanical complications were reported as occurring in 46.9%, hemorrhagic complications in 59.7%, neurological complications in 23.1%, renal complications in 52.5%, cardiac complications in 98.5%, pulmonary complications in 7.8%, and infectious complications in 12.2% of the cases. 15 In our study, mechanical complications were found to occur in 9.8% of the cases. In our previous study, the incidence of mechanical complications was similarly 9% in patients receiving ECMO with the Medos DP3 system.…”

“…There have also been reports showing that the development of hemorrhagic complications has a negative effect on weaning and discharge. 15,37 In our study, we observed statistically significant differences between the survivor-todischarge and non-survivor groups in terms of mechanical (p = 0.02), neurological (p = 0.001), renal (p = 0.001), and infectious (p = 0.01) complications.…”

“…In other single-center studies, survival rates after ECMO in neonatal and pediatric patient groups range between 33% and 67%. 5,[10][11][12][13][14][15][16] In the ECLS Registry Report International Summary of January 2017, in neonatal cardiac patients, mechanical complications were reported as occurring in 45.8%, hemorrhagic complications in 56.2%, neurological complications in 25.2%, renal complications in 52.2%, cardiac complications in 96.1%, pulmonary complications in 7.7%, and infectious complications in 8.1% of the cases.…”

“…[26][27][28][29] However, some single-center publications have reported better survival rates of 61%. 15 In the case of ECMO support after Glenn and Fontan operations, it is reported that the risk of neurological complications increases due to intracranial venous stasis. [26][27][28][29] Asano et al emphasized that better single-ventricular physiology ECMO results may be related to better venous return due to bicaval venous cannulation.…”

Outcome of Cardiac ECMO in Children Less than 1 Year Age Undergoing Corrective Cardiac Surgery

“…The survival after VA ECMO in children varies between 36 to 48%. [4][5][6][7][8][9][10] The children in our study had a median age and weight of 60 days and 3.4 kg, respectively. Eighty five percent of our study children underwent arterial switch operation (RACHS-4).…”