Extracorporeal life support after cardiac surgery in children: outcomes from a single institution

Area of Science:

• Pediatric Cardiac Surgery
• Extracorporeal Life Support (ECLS)
• Cardiology

Background:

• Extracorporeal life support (ECLS) is a critical intervention for pediatric patients experiencing complications post-congenital heart surgery.
• Indications include failure to separate from cardiopulmonary bypass, low cardiac output syndrome, and extracorporeal cardiopulmonary resuscitation.
• Understanding ECLS outcomes is vital for improving survival in this vulnerable population.

Purpose of the Study:

• To evaluate the outcomes of pediatric patients requiring postoperative ECLS at a single institution.
• To compare survival and device weaning rates between different ECLS modalities and patient heart anatomies.
• To identify factors influencing successful ECLS discontinuation and hospital discharge.

Main Methods:

• Retrospective review of medical records for all pediatric patients who underwent cardiac surgery and required postoperative ECLS between 2003 and 2011.
• Data collected included patient demographics, ECLS type (extracorporeal membrane oxygenation [ECMO] or ventricular assist system [VAS]), duration of support, and clinical outcomes.
• Statistical analysis compared survival-to-discharge rates between biventricular heart (BVH) and univentricular heart (UVH) patients, and between ECMO and VAS use in UVH patients.

Main Results:

• 36 out of 2541 pediatric cardiac surgical cases (1.4%) required postoperative ECLS.
• Overall, 58% of patients were weaned off ECLS, and 47% were discharged from the hospital.
• Patients with biventricular hearts (BVH) demonstrated significantly higher survival-to-hospital discharge rates compared to univentricular heart (UVH) patients (P=0.019). UVH patients on VAS had higher device discontinuation rates than those on ECMO (P=0.012), though hospital discharge rates were similar.

Conclusions:

• Extracorporeal life support (ECLS) is a beneficial therapy for children with low cardiac output following complex cardiac surgery.
• Biventricular heart (BVH) anatomy is associated with improved survival-to-discharge rates compared to univentricular heart (UVH) anatomy.
• Surgical interventions aimed at reducing ventricular volume overload, such as shunt banding or bidirectional cavopulmonary shunts, may facilitate ECLS weaning in UVH patients.