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Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome
T K Susheel Kumar1, David Zurakowski, Heidi Dalton
1Department of Cardiovascular Surgery, Children's National Medical Center, Washington, DC, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) in children post-cardiac surgery is associated with significant morbidity and mortality. Key predictors of poor outcomes include prolonged ECMO duration, renal failure, and low urine output.
Area of Science:
- Pediatric Cardiac Surgery
- Extracorporeal Life Support
- Critical Care Medicine
Background:
- Pediatric patients undergoing cardiac surgery often require extracorporeal membrane oxygenation (ECMO) for life support.
- Assessing outcomes and identifying risk factors for morbidity and mortality in this population is crucial.
Purpose of the Study:
- To evaluate the morbidity and mortality rates in children supported by ECMO after cardiac surgery.
- To identify independent factors that influence patient outcomes, including survival to discharge.
Main Methods:
- A retrospective study of 58 pediatric patients who received ECMO post-cardiac surgery between 2003 and 2008.
- Logistic regression modeling was used to determine predictors of outcome based on multivariate analysis.
Main Results:
- Of 58 patients, 41% survived to hospital discharge. Major complications included renal failure (31%), neurologic issues (29%), and sepsis (16%).
- Independent factors for failure to wean from ECMO included prolonged support (>10 days), low urine output (<2 mL/kg/hr), renal failure, and low pH (<7.35).
- Factors for mortality post-decannulation included extended ECMO duration, high blood transfusion volumes, and sepsis. Single ventricle repair patients faced higher mortality risk.
Conclusions:
- Prolonged ECMO support, early low urine output and pH, and renal failure are significant mortality predictors during ECMO.
- High blood transfusion, extended ECMO, and sepsis increase the risk of death even after successful ECMO weaning.
Objective:
Our objective was to assess the morbidity and mortality in children requiring extracorporeal membrane oxygenator support after cardiac surgery and to determine factors influencing outcome.
Methods:
Between January 2003 and June 2008, 58 patients required extracorporeal membrane oxygenator support after cardiac surgery. A retrospective study was performed and factors influencing outcome were determined by logistic regression modeling with the probability of outcome based on a combination of multivariate predictors.
Results:
Median age and weight were 12 days and 3.3 kg, respectively. Thirty-one patients had single ventricle repair and 27 had biventricular repair. Median duration of support with the oxygenator was 6 days. Thirty-nine (67%) patients were successfully weaned off the support, but only 24 (41%) survived to hospital discharge. Chief complications were renal failure (31%), neurologic complications (29%), and sepsis (16%). Multivariable logistic regression analysis identified 10 days or more of extracorporeal membrane oxygenation (odds ratio = 6.1), urine output less than 2 mL x kg(-1) x h(-1) in first 24 hours (odds ratio = 15), renal failure (odds ratio = 9.4), and pH less than 7.35 after 24 hours of extracorporeal membrane oxygenation (odds ratio = 82) as significant independent factors associated with failure to wean off extracorporeal membrane oxygenation. Factors associated with failure of hospital discharge despite successful decannulation were as follows: extracorporeal membrane oxygenator support time of 10 days or more, red blood cell transfusion of greater than 1000 mL/kg during the entire period of oxygenator support, and sepsis. Patients with single ventricle repair were at higher risk of hospital mortality.
Conclusion:
Longer duration of extracorporeal membrane oxygenator support, low pH and urine output in the first 24 hours, and renal failure are significant factors associated with mortality during extracorporeal membrane oxygenator support. Exposure to high amounts of blood transfusion during extracorporeal oxygenation, extended extracorporeal membrane oxygenator support, and sepsis increase risk of death after successful decannulation.
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