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Extracorporeal membrane oxygenation in children after cardiac surgery
S C Raithel1, D G Pennington, E Boegner
1Division of Cardiovascular Surgery, St. Louis University Medical Center, MO 63110-0250.
Insights
Extracorporeal membrane oxygenation (ECMO) offers a chance for myocardial recovery in children with refractory postcardiotomy failure. This life support can enable survival for critically ill pediatric cardiac surgery patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- 65 children (1 day-14 years) received extracorporeal membrane oxygenation (ECMO) between 1982-1991 after cardiac surgery.
- 44% (67.7%) were weaned from ECMO, with 23 (35.4%) surviving.
Purpose of the Study:
- To identify pre-ECMO factors predicting survival in pediatric cardiac surgery patients.
- To evaluate the efficacy of ECMO in facilitating myocardial recovery and survival.
Main Methods:
- Analysis of 29 pre-ECMO variables including diagnosis, age, sex, blood gas data, hemodynamics, and renal function.
- Statistical analysis to determine predictors of survival.
- Long-term follow-up of survivors.
Main Results:
- Lower preoperative systemic ventricular shortening fraction was observed in survivors.
- Need for dialysis and duration of ECMO support were significant predictors of survival.
- 17 of 18 long-term survivors (mean follow-up 37.5 months) are in New York Heart Association functional class I.
Conclusions:
- ECMO facilitates myocardial recovery in most pediatric patients with refractory postcardiotomy failure.
- ECMO provides a survival benefit for select pediatric cardiac surgery patients who would not otherwise survive.
Background:
From August 1982 to May 1991, 65 children (32 boys), 1 day to 14 years old, received extracorporeal membrane oxygenation (ECMO) 0-50 hours after cardiac surgery. Forty-four (67.7%) were weaned, with 23 (35.4%) survivors.
Methods And Results:
Analysis of 29 pre-ECMO factors including diagnosis, age, sex, blood gas data, systemic pressures, atrial pressures, ventricular function, and renal function was performed. Preoperative systemic ventricular shortening fraction was statistically less in survivors. The need for dialysis and length of support were predictors of survival once ECMO was initiated. There were five late deaths 6 days to 5 years after discharge; none were related to ECMO. The remaining 18 patients have been followed for a mean of 37.5 months (range, 1-85 months). Seventeen are New York Heart Association functional class I, with one patient still hospitalized.
Conclusions:
ECMO allows for myocardial recovery in the majority of patients with refractory postcardiotomy failure and permits some patients to survive who would not have otherwise.
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