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Delayed extracorporeal membrane oxygenation in children after cardiac surgery: two-institution experience
Punkaj Gupta1, Rahul DasGupta2, Derek Best3
11Department of Pediatrics,Division of Pediatric Cardiology,University of Arkansas for Medical Sciences,Little Rock,United States of America.
Insights
Outcomes for children receiving delayed extracorporeal membrane oxygenation (ECMO) after cardiac surgery are similar to those receiving early ECMO. This study highlights the diverse causes and comparable survival rates for delayed ECMO in pediatric cardiac patients.
Area of Science:
- Pediatric Cardiac Surgery
- Extracorporeal Membrane Oxygenation (ECMO)
- Critical Care Medicine
Background:
- Limited data exist on outcomes for children requiring delayed extracorporeal membrane oxygenation (≥7 days) post-cardiac surgery.
- Understanding the reasons for and results of delayed ECMO is crucial for optimizing pediatric cardiac critical care.
Purpose of the Study:
- To determine the aetiology and outcomes of delayed extracorporeal membrane oxygenation (≥7 days) in children after cardiac surgery.
- To compare outcomes between children receiving early (<7 days) versus delayed (≥7 days) ECMO post-cardiac surgery.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) who received ECMO after cardiac surgery between 2001 and 2012.
- Data collected included demographics, diagnoses, ECMO indications, support details, medical/surgical history, lab results, organ dysfunction, complications, and survival.
- Outcomes focused on survival to discharge and current survival, assessing neurological, renal, and pulmonary function.
Main Results:
- Overall survival was 55% (232/423 patients) among all ECMO patients post-cardiac surgery.
- Survival for delayed ECMO (≥7 days) was 52% (27/52 patients), comparable to early ECMO (<7 days) at 55% (205/371 patients).
- Complications included active CPR during ECMO (25%), dialysis (44%), positive blood cultures (15%), bleeding (16%), and cerebrovascular events (18%).
Conclusions:
- Mortality outcomes are comparable between children receiving delayed (≥7 days) and early (<7 days) extracorporeal membrane oxygenation after cardiac surgery.
- The cohort receiving delayed ECMO post-cardiac surgery was small, with a diverse range of underlying aetiologies.
- Further research may be needed to explore specific indications and management strategies for delayed ECMO in this population.
Objective:
There are limited data on the outcomes of children receiving delayed (≥7 days) extracorporeal membrane oxygenation after cardiac surgery. The primary aim of this project is to identify the aetiology and outcomes of extracorporeal membrane oxygenation in children receiving delayed (≥7 days) extracorporeal membrane oxygenation after cardiac surgery.
Patients And Methods:
We conducted a retrospective review of all children ≤18 years supported with delayed extracorporeal membrane oxygenation after cardiac surgery between the period January, 2001 and March, 2012 at the Arkansas Children's Hospital, United States of America, and Royal Children's Hospital, Australia. The data collected in our study included patient demographic information, diagnoses, extracorporeal membrane oxygenation indication, extracorporeal membrane oxygenation support details, medical and surgical history, laboratory, microbiological, and radiographic data, information on organ dysfunction, complications, and patient outcomes. The outcome variables evaluated in this report included: survival to hospital discharge and current survival with emphasis on neurological, renal, pulmonary, and other end-organ function.
Results:
During the study period, 423 patients undergoing cardiac surgery were supported with extracorporeal membrane oxygenation at two institutions, with a survival of 232 patients (55%). Of these, 371 patients received extracorporeal membrane oxygenation <7 days after cardiac surgery, with a survival of 205 (55%) patients, and 52 patients received extracorporeal membrane oxygenation ≥7 days after cardiac surgery, with a survival of 27 (52%) patients. The median duration of extracorporeal membrane oxygenation run for the study cohort was 5 days (interquartile range: 3, 10). In all, 14 patients (25%) received extracorporeal membrane oxygenation during active cardiopulmonary resuscitation with chest compressions. There were 24 patients (44%) who received dialysis while being on extracorporeal membrane oxygenation. There were eight patients (15%) who had positive blood cultures and four patients (7%) who had positive urine cultures while being on extracorporeal membrane oxygenation. There were nine patients (16%) who had bleeding complications associated with extracorporeal membrane oxygenation runs. There were 10 patients (18%) who had cerebrovascular thromboembolic events associated with extracorporeal membrane oxygenation runs. Of these, 19 patients are still alive with significant comorbidities.
Conclusions:
This study demonstrates that mortality outcomes are comparable among children receiving extracorporeal membrane oxygenation ≥7 days and <7 days after cardiac surgery. The proportion of patients receiving extracorporeal membrane oxygenation ≥7 days is small and the aetiology diverse.
