Related Experiment Video
Updated: May 12, 2026
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Residual lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation
Hemant S Agarwal1, Daphne C Hardison2, Benjamin R Saville3
1Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn.
Insights
Residual lesions affect about 28% of pediatric cardiac surgery patients needing extracorporeal membrane oxygenation (ECMO). Early detection and intervention for these lesions significantly improve decannulation and survival rates.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Extracorporeal Membrane Oxygenation (ECMO)
Background:
- Postoperative complications following pediatric cardiac surgery can necessitate extracorporeal membrane oxygenation (ECMO) support.
- Residual cardiac lesions may impede successful weaning from ECMO and impact patient outcomes.
Purpose of the Study:
- To determine the incidence of residual lesions in pediatric cardiac surgery patients requiring ECMO.
- To investigate the clinical outcomes associated with residual lesions in this patient population.
Main Methods:
- Retrospective observational study of 119 pediatric cardiac surgery patients on ECMO (2005-2011).
- Definition of residual lesion: hemodynamically significant cardiac lesion requiring intervention for ECMO decannulation.
- Analysis of demographic, surgical, ECMO, echocardiographic, and cardiac catheterization data.
Main Results:
- Residual lesions were identified in 35 of 119 patients (28%), most commonly in branch pulmonary arteries, shunts, and ventricular outflow tracts.
- Cardiac catheterization detected 80% of residual lesions, while echocardiography detected 20%.
- Earlier detection (within 3 days of ECMO) correlated with significantly improved decannulation rates (P=.004) and survival to discharge (P=.035).
Conclusions:
- Approximately one-quarter of pediatric cardiac surgery patients on ECMO have residual lesions.
- Active evaluation for residual lesions, preferably via cardiac catheterization, is recommended for patients unable to wean from ECMO.
- Early identification and reintervention for residual lesions are linked to better clinical outcomes.
Objective:
The objective of this study was to examine the incidence and clinical outcomes of residual lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation (ECMO) support.
Methods:
A retrospective observational study was undertaken at a pediatric heart institution. Postoperative pediatric cardiac surgery patients receiving ECMO support within 7 days of surgery during the past 7 years (2005-2011) were studied. A hemodynamically significant cardiac lesion on ECMO support that required intervention to decannulate successfully was defined as a residual lesion. Demographic data, complexity of cardiac defect, surgical data, indications for ECMO, echocardiographic findings, and cardiac catheterization results were studied. Evaluation of residual lesions based on duration of ECMO support, interventions undertaken, and clinical outcomes were also examined.
Results:
Residual lesions were evaluated in 43 of 119 postoperative patients placed on ECMO support. Lesions were detected in 35 patients (28%), predominantly in branch pulmonary arteries (n = 10), shunts (n = 7), and ventricular outflow tracts (n = 9). Echocardiography detected 7 residual lesions (20%) and cardiac catheterization detected 28 residual lesions (80%). Earlier detection of residual lesions during the first 3 days of ECMO support in 24 patients improved their rate of decannulation significantly (P = .004) and survival to hospital discharge (P = .035), compared with later detection (after 3 days of ECMO support) in 11 patients.
Conclusions:
Residual lesions are present in approximately one-quarter of postoperative cardiac surgery patients requiring ECMO support. All postoperative pediatric cardiac surgery patients unable to be weaned off ECMO successfully should be evaluated actively for residual lesions, preferably by cardiac catheterization imaging. Earlier detection of residual lesions and reintervention are associated with improved clinical outcome.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...