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Cardiac ECMO for biventricular hearts after paediatric open heart surgery

R R Chaturvedi1, D Macrae, K L Brown

  • 1Randall Centre, King's College, London, UK.

Heart (British Cardiac Society)
|April 16, 2004
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) in children with biventricular hearts after surgery offers a 49% survival rate. Early ECMO initiation in the operating room significantly improves outcomes, highlighting the importance of timely intervention.

Area of Science:

  • Pediatric Cardiology
  • Cardiothoracic Surgery
  • Critical Care Medicine

Background:

  • Children with biventricular physiology undergoing open heart surgery face significant risks.
  • Extracorporeal membrane oxygenation (ECMO) is a critical support system for these complex cases.
  • Predicting survival in this high-risk population remains a challenge.

Purpose of the Study:

  • To identify predictors of hospital survival in pediatric patients with biventricular hearts requiring ECMO post-open heart surgery.
  • To evaluate the impact of ECMO initiation timing and specific clinical factors on survival outcomes.

Main Methods:

  • Retrospective analysis of 81 children with biventricular physiology supported by ECMO after open heart surgery.
  • Comparison of survival rates based on ECMO initiation location (operating room vs. cardiac intensive care unit).
  • Identification of adverse factors associated with hospital survival.

Main Results:

  • Overall hospital survival was 49% (40 of 81), with 18% late deaths among survivors.
  • Initiating ECMO in the operating room (64% survival) significantly improved outcomes compared to the ICU (29% survival).
  • Reactive pulmonary hypertension was a positive prognostic factor, while circuit problems, renal support, residual lesions, and ECMO duration were adverse factors.

Conclusions:

  • Hospital survival for children with biventricular physiology on ECMO is comparable to mixed populations, emphasizing the need to identify reversible dysfunction.
  • Early ECMO support initiated in the operating room prevents hypoperfusion and cardiac arrest, leading to better survival.
  • Successful cardiac ECMO hinges on identifying hearts with potentially reversible ventricular dysfunction.
Abstract

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