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Published on: October 24, 2018
Determinants of success in pediatric cardiac patients undergoing extracorporeal membrane oxygenation
M D Black1, J G Coles, W G Williams
1Department of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Successful cardiac recovery using extracorporeal membrane oxygenation (ECMO) is possible in nearly 70% of pediatric patients without postcardiotomy residual defects, with most recovery occurring within 6 days of ECMO support.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for severe myocardial failure.
- Predicting successful cardiac recovery and understanding ECMO's limitations are crucial.
Purpose of the Study:
- To identify predictors of successful cardiac recovery in pediatric patients undergoing ECMO.
- To determine the practical limitations of ECMO support in pediatric cardiac failure.
Main Methods:
- Retrospective analysis of 31 pediatric patients with myocardial failure treated with ECMO.
- Data collection on patient demographics, indications for ECMO, and outcomes.
Main Results:
- Overall successful weaning rate from ECMO was 45% (14/31).
- Patients with postcardiotomy myocardial dysfunction (n=25) had lower survival than those with cardiomyopathy/myocarditis (n=6).
- Children with residual defects post-cardiotomy (n=10) did not survive ECMO; ECMO support beyond 6 days was unsuccessful.
Conclusions:
- Postcardiotomy residual defects are a contraindication for ECMO.
- Excluding patients with residual defects, successful ECMO weaning rates approach 70%.
- Optimal recovery with ECMO typically occurs within the first 6 days of support.
Background:
The purpose of this retrospective study is to determine the possible predictors of successful cardiac recovery using extracorporeal membrane oxygenation (ECMO) and the practical limits of ECMO support.
Methods:
Information was gathered on 31 consecutive children with myocardial failure who could not be resuscitated with other means and underwent ECMO at the Hospital for Sick Children before January 1994.
Results:
Of the children who underwent ECMO as a means of cardiac rescue, 14/31 (45%) were weaned successfully. Two distinct groups of children were evident based on their initial indications for ECMO: those who had postcardiotomy myocardial dysfunction (n = 25) and those with cardiomyopathy or myocarditis (n = 6). Children with residual defects after cardiotomy (n = 10) did not survive ECMO. Four of the 6 children with cardiomyopathy or myocarditis were weaned successfully. In either group of patients ECMO support beyond 6 days failed to resuscitate the myocardium; all attempts to violate this "time barrier" in our study inevitably failed.
Conclusions:
Postcardiotomy residual defects are a contraindication to ECMO. If children with residual defects are excluded, successful weaning from ECMO can be achieved in almost 70%, with almost all recovery occurring with the first 6 days of ECMO.
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