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Extracorporeal membrane oxygenation in pediatric patients: our experience in the last ten years
Lior Sasson1, Ilan Cohen, Akiva Tamir
1Department of Cardiothoracic Surgery, Wolfson Medical Center, Holon, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. dawn@wolfson.health.gov.il
Insights
Extracorporeal membrane oxygenation (ECMO) offers survival benefits for pediatric post-cardiotomy heart failure patients. Early use in cardiopulmonary resuscitation is recommended for improved outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiothoracic Surgery
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is an established treatment for children post-cardiac surgery.
- ECMO is increasingly utilized as a cardiopulmonary resuscitation tool in specialized centers.
Purpose of the Study:
- To evaluate the utilization and outcomes of ECMO in pediatric patients over a 10-year period.
- To analyze patient demographics, procedures, and support duration for ECMO recipients.
Main Methods:
- Retrospective review of 62 pediatric patients supported with ECMO between 2000 and 2010.
- Analysis included patient age, weight, cardiac anomalies, surgical procedures (e.g., arterial switch operation), and ECMO support duration.
- Outcomes assessed included renal failure requiring hemofiltration/dialysis and overall hospital survival rate.
Main Results:
- The median age was 3 months, with a median weight of 4.3 kg.
- 52.3% of patients required renal support; arterial switch operations were the most common procedure (27.4%).
- The overall hospital survival rate was 38.7%, with 46.7% successfully weaned from ECMO.
Conclusions:
- ECMO provides a significant survival advantage for pediatric patients experiencing post-cardiotomy heart failure.
- Timely initiation of ECMO support in cardiopulmonary resuscitation scenarios is crucial for improving patient survival.
Background:
The use of extracorporeal membrane oxygenation (ECMO) in children after cardiac surgery is well established. ECMO support is becoming an integral tool for cardiopulmonary resuscitation in specified centers.
Objectives:
To review our use of ECMO over a 10 year period.
Methods:
All children supported with ECMO from 2000 to 2010 were reviewed. Most of these children suffered from cardiac anomalies. The patients were analyzed by age, weight, procedure, RACHS-1 when appropriate, length of support, and outcome.
Results:
Sixty-two children were supported with ECMO; their median age was 3 months (range 0-216 months) and median weight 4.3 kg (range 1.9-51 kg). Thirty-four patients (52.3%) needed additional hemofiltration or dialysis due to renal failure. The children requiring ECMO support represented a wide spectrum of cardiac lesions; the most common procedure was arterial switch operation (27.4%, n=17). ECMO was required mainly for failure to separate from the heart-lung machine (n=55). The median duration of ECMO support was 4 days (range 1-14 days); 29 (46.7%) patients were weaned successfully from ECMO during this time period, and 5 of them died during hospitalization, yielding an overall hospital survival rate of 38.7%.
Conclusions:
ECMO support has significant survival benefit for patients with post-cardiotomy heart failure. Its early deployment should be considered in cardiopulmonary resuscitation.
