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Extracorporeal membrane oxygenation for cardiac support in pediatric patients
1Ohio State University College of Medicine and Public Health, Columbus, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) offers pediatric cardiac support. ECMO as a bridge to cardiac transplant showed higher survival rates than post-cardiotomy support, with early recovery crucial.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Severe myocardial dysfunction necessitates advanced cardiac support in children.
- Extracorporeal membrane oxygenation (ECMO) is a vital tool for pediatric cardiac support.
- Outcomes vary significantly based on ECMO application.
Purpose of the Study:
- To evaluate the effectiveness of ECMO in pediatric patients with severe myocardial dysfunction.
- To compare ECMO outcomes in different clinical scenarios: post-cardiotomy, bridge to transplant, and post-transplant support.
- To identify predictors of survival in pediatric ECMO patients.
Main Methods:
- Retrospective review of 34 pediatric patients (<18 years) undergoing ECMO from March 1995 to May 1999.
- Univariate analysis of demographic, cardiac, noncardiac, and outcome variables.
- Stratification into three groups: post-cardiac surgery (A), bridge to transplant (B), and failed transplant support (C).
Main Results:
- Survival to discharge was 22% for Group A, 46% for Group B, and 66% for Group C.
- Multiorgan system failure was the primary cause of death (68%).
- Support exceeding 6 days in Group A was associated with nonsurvival; mediastinal bleeding and renal failure predicted poor outcomes.
Conclusions:
- ECMO as a bridge to cardiac transplantation is more successful than post-cardiotomy support.
- Early recovery of cardiac function (within the first week) is critical for survival.
- Mediastinal bleeding and renal failure are significant negative prognostic indicators in pediatric ECMO.
Abstract:
Extracorporeal membrane oxygenation (ECMO) has been used for pediatric cardiac support in settings of expected mortality due to severe myocardial dysfunction. We reviewed the records of 34 children (<18 years) placed on ECMO between March 1995 and May 1999. Demographic, cardiac, noncardiac, and outcome variables were recorded. Data were subjected to univariate analysis to define predictors of outcome. Eighteen patients were placed on ECMO after cardiac surgery (Group A); seven of 18 were weaned off ECMO, and four survived to discharge (22%). Thirteen patients were placed on ECMO as a bridge to cardiac transplantation (Group B), six of 13 received a heart transplant, one recovered spontaneously, and six survived to discharge (46%). Three patients were placed on ECMO for failed cardiac transplantation while awaiting a second transplant (Group C); one recovered graft function, two received a second heart transplant, and two of three survived (66%). The primary cause of death was multiorgan system failure (68%). Group A patients supported on ECMO for more than 6 days did not survive. Mediastinal bleeding complications and renal failure requiring dialysis were associated with nonsurvival. We conclude that ECMO as a bridge to cardiac transplant was more successful than ECMO support after cardiotomy. Mediastinal bleeding and renal failure were associated with poor outcome. Recovery of cardiac function occurred within the first week of ECMO support if at all. Longer support did not result in survival without transplantation.