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Empowering Little Fighters: Post-Cardiotomy Pediatric ECMO and the Journey to Recovery
Alok Kumar1, Sangeeth Raj2, Saurabh Singh3
1Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India.
Insights
Early initiation of Extra Corporeal Membrane Oxygenation (ECMO) in pediatric cardiac surgery patients shows a 58.3% survival rate. Key factors for survival include improved pH and lactate levels, while sepsis and arrhythmia negatively impact outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiorespiratory Support
- Extracorporeal Membrane Oxygenation
Background:
- Extra Corporeal Membrane Oxygenation (ECMO) is utilized for cardiorespiratory support post-pediatric cardiac surgery, with historically low success rates (2-3%).
- Optimal critical care delivery and a multidisciplinary team are crucial for patient recovery.
Purpose of the Study:
- To evaluate the survival benefit of central veno-arterial (VA) ECMO in children undergoing elective cardiac surgeries for congenital heart disease.
- To identify factors associated with survival in this pediatric cohort.
Main Methods:
- A retrospective cohort study of 672 pediatric patients (29 cases) on central VA ECMO from Jan 2018 to Dec 2022.
- Indications for ECMO included inability to wean from cardiopulmonary bypass, low cardiac output syndrome, pulmonary hypertension, bleeding, anaphylaxis, respiratory failure, and pulmonary edema.
Main Results:
- The mean time to ECMO initiation was under 5 hours, with a mean support duration of 56 hours.
- A survival rate of 58.3% was observed.
- Sepsis and arrhythmia were associated with decreased survival, while improvements in pH, PaO2, and lactate levels correlated with better outcomes.
Conclusions:
- Early ECMO initiation for pediatric cardiotomies offers a potential lifeline for critically ill patients.
- Positive outcomes are linked to improved perfusion indicators (pH, lactate) and the absence of complications like arrhythmia and sepsis.
Introduction:
Extra Corporeal Membrane Oxygenation (ECMO) has long been used for cardiorespiratory support in the immediate post-paediatric cardiac surgery period with a 2-3% success as per the ELSO registry. Success in recovery depends upon the optimal delivery of critical care to paediatric patients and a comprehensive healthcare team.
Methodology:
The survival benefit of children placed on central veno arterial (VA) ECMO following elective cardiac surgeries for congenital heart disease (n = 672) was studied in a cohort of 29 (4.3%) cases from the period of Jan 2018 to Dec 2022 in our cardiac surgical centre. Indications for placing these patients on central VA ECMO included inability to wean from cardiopulmonary bypass (CPB), low cardiac output syndrome, severe pulmonary arterial hypertension, significant bleeding, anaphylaxis, respiratory failure and severe pulmonary edema.
Results:
The mean time to initiation of ECMO was less than 5 h and the mean duration of ECMO support was 56 h with a survival rate of 58.3%. Amongst perioperative complications, sepsis and arrhythmia on ECMO were found to be negatively associated with survival. Improvements in the pH, PaO2 levels and serum lactate levels after initiation of ECMO were associated with survival benefits.
Conclusion:
The early initiation of ECMO for paediatric cardiotomies could be a beacon of hope for families and medical teams confronting these challenging situations. Improvement in indicators of adequate perfusion and ventricular recoveries like pH and serum lactate and absence of arrhythmia and sepsis are associated with good outcomes.
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