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Published on: May 26, 2023
Outcomes following extracorporeal membrane oxygenation in children with cardiac disease
Kate L Brown1, Rebecca Ichord, Bradley S Marino
1Cardiac Unit, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute for Cardiovascular Science University College London, London, United Kingdom. Katherine.Brown@gosh.nhs.uk
Insights
Extracorporeal membrane oxygenation (ECMO) supports children with heart failure, with a 40% survival rate to discharge. Understanding ECMO outcomes is crucial for guiding its use in pediatric cardiac care.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital mechanical circulatory support for pediatric patients with severe heart disease and failure.
- It is employed when conventional therapies fail, including during cardiac arrest unresponsive to resuscitation.
Purpose of the Study:
- To review current knowledge on short- and long-term outcomes of ECMO in children with cardiac disease.
- To inform the appropriate use and future development of ECMO in pediatric cardiac critical care.
Main Methods:
- Systematic review of existing literature on ECMO outcomes in pediatric cardiac patients.
- Analysis of survival rates, complications, and functional/neurologic outcomes.
Main Results:
- Survival to hospital discharge for pediatric cardiac patients on ECMO is approximately 40%.
- Outcomes vary significantly based on patient age, indication for support, and underlying cardiac condition.
- ECMO, while lifesaving, is associated with significant complications and high costs.
Conclusions:
- A comprehensive understanding of ECMO's short- and long-term results is essential for optimizing its application in pediatric cardiac care.
- Further research and standardized guidelines are needed to improve patient outcomes and resource utilization.
Abstract:
Extracorporeal membrane oxygenation is a commonly used form of mechanical circulatory support in children with congenital or acquired heart disease and cardiac failure refractory to conventional medical therapies. In children with heart disease who suffer cardiac arrest, extracorporeal membrane oxygenation has been successfully used to provide cardiopulmonary support when conventional resuscitation has failed to establish return of spontaneous circulation. Survival to hospital discharge for children with heart disease support is approximately 40% but varies widely based on age, indication for support, and underlying cardiac disease. Although extracorporeal membrane oxygenation is lifesaving in many instances, it is associated with many complications and is expensive. Thus, a clear understanding of survival to discharge and long-term functional and neurologic outcomes are essential to guide the use of extracorporeal membrane oxygenation now and in the future. This review, part of the Pediatric Cardiac Intensive Care Society/Extracorporeal Life Support Organization Joint Statement on Mechanical Circulatory Support, summarizes current knowledge on short- and long-term outcomes for extracorporeal membrane oxygenation used to support children with cardiac disease.
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