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Major surgical intervention during extracorporeal membrane oxygenation
J B Atkinson1, H Kitagawa, B Humphries
1Division of Pediatric Surgery, Childrens Hospital of Los Angeles, CA 90027.
Journal of Pediatric Surgery
|September 1, 1992
Summary
Surgical procedures during extracorporeal membrane oxygenation (ECMO) are feasible. Best outcomes for ECMO patients undergoing surgery occur with rapid decannulation post-procedure, suggesting delayed interventions until near ECMO cessation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Surgery
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) provides vital cardiorespiratory support.
- Surgical interventions in patients on ECMO present unique challenges.
- Understanding outcomes of surgery during ECMO is crucial for patient management.
Purpose of the Study:
- To evaluate the feasibility and outcomes of surgical procedures performed on patients receiving ECMO.
- To identify factors influencing survival and complications in this patient population.
Main Methods:
- Retrospective review of 135 patients treated with ECMO from January 1987 to December 1989.
- Analysis of 19 patients who underwent surgical procedures while on ECMO.
- Categorization of surgeries by indication (hemorrhage, congenital pathology).
Main Results:
- 19 out of 135 ECMO patients (14.0%) required surgery.
- Hemorrhage-related surgeries were most common (13 patients), with 4 deaths among 6 requiring reoperation.
- Congenital pathology surgeries (6 patients) had better outcomes, with 4 immediate decannulations.
- Overall survival for surgically treated ECMO patients was 13 out of 19.
- Survivors were decannulated at a mean of 45 hours post-op, while non-survivors averaged 90 hours.
Conclusions:
- Surgical intervention on ECMO is technically feasible.
- Rapid postoperative discontinuation of ECMO is associated with improved survival.
- Major surgical interventions should ideally be delayed until near the end of ECMO therapy.