Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery
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Published on: May 26, 2023
Ahmed M Dohain1,2, Gaser Abdelmohsen1,2, Ahmed A Elassal3,4
1Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.
Insights
Extracorporeal membrane oxygenation (ECMO) use after pediatric cardiac surgery shows better survival for biventricular repairs. Capillary leak during ECMO may increase mortality risk in these complex cases.
Area of Science:
- Pediatric Cardiac Surgery
- Extracorporeal Membrane Oxygenation
- Congenital Heart Defects
Background:
- Extracorporeal membrane oxygenation (ECMO) is crucial for neonates and infants with complex congenital heart defects (CHDs) undergoing intricate cardiac surgeries.
- Increasing complexity of pediatric cardiac surgical repairs necessitates advanced support like ECMO.
Purpose of the Study:
- To evaluate survival outcomes for pediatric patients requiring ECMO support post-cardiac surgery.
- To compare survival rates between biventricular repair and univentricular palliation in ECMO-supported pediatric cardiac surgery patients.
Main Methods:
- Retrospective review of medical records for patients with CHDs requiring cardiac surgery and ECMO support.
- Data collected from November 2015 to November 2018 at King Abdulaziz University Hospital.
- Analysis of patient demographics, surgical repair type, ECMO parameters, and survival outcomes.
Main Results:
- 30 patients (4% of 746) received ECMO support post-cardiac surgery.
- Overall survival to hospital discharge was 40% (12 patients).
- Biventricular repair patients had a higher survival rate (55.55%) compared to single ventricle palliation (16.66%).
- Successfully decannulated patients showed a significant reduction in ECMO flow rate within 4 hours.
Conclusions:
- Biventricular repair is associated with better survival outcomes than univentricular palliation in pediatric cardiac surgery patients requiring ECMO.
- Capillary leak during ECMO may represent a significant risk factor for mortality in this patient population.
Background:
Extracorporeal membrane oxygenation has been widely used after paediatric cardiac surgery due to increasing complex surgical repairs in neonates and infants having complex CHDs.
Materials And Methods:
We reviewed retrospectively the medical records of all patients with CHD requiring corrective or palliative cardiac surgery at King Abdulaziz University Hospital that needed extracorporeal membrane oxygenation support between November 2015 and November 2018.
Results:
The extracorporeal membrane oxygenation population was 30 patients, which represented 4% of 746 children who had cardiac surgery during this period. The patients' age range was from 1 day to 20.33 years, with a median age of 6.5 months. Median weight was 5 kg (range from 2 to 53 kg). Twenty patients were successfully decannulated (66.67%), and 12 patients (40%) were survived to hospital discharge. Patients with biventricular repair tended to have better survival rate compared with those with single ventricle palliation (55.55 versus 16.66%, p-value 0.058). During the first 24 hours of extracorporeal membrane oxygenation support, the flow rate was significantly reduced after 4 hours of extracorporeal membrane oxygenation connection in successfully decannulated patients.
Conclusion:
Survival to hospital discharge in patients requiring extracorporeal membrane oxygenation support after paediatric cardiac surgery was better in those who underwent biventricular repair than in those who had univentricular palliation. Capillary leak on extracorporeal membrane oxygenation could be a risk of mortality in patients after paediatric cardiac surgery.
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