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Extracorporeal membrane oxygenation for cardiac rescue in children with severe myocardial dysfunction
H J Dalton1, R D Siewers, B P Fuhrman
1Department of Anesthesiology/Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, PA.
Insights
Extracorporeal membrane oxygenation (ECMO) effectively rescues pediatric patients with severe cardiac dysfunction, aiding myocardial recovery and serving as a bridge to heart transplantation. This life-saving technology offers significant survival benefits for critically ill children.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Severe myocardial dysfunction in pediatric patients often presents a lethal challenge.
- Conventional therapies may be insufficient for patients with critical cardiac failure.
- Extracorporeal membrane oxygenation (ECMO) is an advanced life support technique.
Purpose of the Study:
- To evaluate the efficacy and experience of using ECMO for cardiac rescue in pediatric patients.
- To assess ECMO's role in supporting patients with life-threatening cardiac dysfunction.
- To determine survival rates and outcomes associated with ECMO therapy.
Main Methods:
- Retrospective analysis of 29 pediatric intensive care unit (ICU) patients over a 9-year period.
- Data collected included patient demographics, cardiac defects, treatment details, and outcomes.
- Statistical comparison between survivors and non-survivors was performed.
Main Results:
- 45% of patients survived to hospital discharge, with a long-term survival rate of 38%.
- 79% recovered myocardial function, and 62% were successfully decannulated.
- ECMO demonstrated a 60% survival rate for bridge-to-transplant patients and 65% for those with cardiac arrest.
Conclusions:
- ECMO provides successful circulatory support for pediatric patients with severe myocardial dysfunction failing conventional therapy.
- It is a viable option for patients with prolonged cardiac arrest unresponsive to resuscitation.
- ECMO serves as an effective mechanical bridge to heart transplantation.
Objective:
To assess the experience and efficacy of extracorporeal membrane oxygenation (ECMO) for cardiac rescue in patients with presumptively lethal cardiac dysfunction at the Children's Hospital of Pittsburgh.
Design:
Retrospective analysis of patient records from a 9-yr period.
Setting:
A 22-bed tertiary care pediatric intensive care unit (ICU) with an average of 1,400 admissions per year. An average of 150 open cardiotomy surgeries are performed per year, and all postoperative and severely ill cardiac patients are cared for in the ICU.
Patients:
A total of 29 pediatric ICU patients with myocardial failure received ECMO throughout the 9-yr study period.
Interventions:
None.
Measurements And Main Results:
Demographic information, underlying cardiac defect, intraoperative and postoperative data, postoperative course, details of ECMO treatment, and outcome were collected. Comparison of survivors with nonsurvivors was performed using the Mann-Whitney U test for continuous variables. Twenty-three (79%) of 29 patients recovered myocardial function while undergoing ECMO, 18 (62%) of 29 patients were successfully decannulated, and 13 (45%) of 29 patients survived to hospital discharge. Long-term survival rate was 11 (38%) of 29 patients. Three (60%) of five bridge-to-heart transplant patients survived. Eleven (65%) of 17 patients who suffered cardiac arrest before ECMO, survived to discharge and nine (53%) of these 17 patients remain long-term survivors. Survival rate in patients who required cardiac massage for > 15 mins before cannulation was six (55%) of 11 patients.
Conclusions:
Patients with severe myocardial dysfunction who fail conventional therapy can be successfully supported with ECMO during the period of myocardial recovery. ECMO can also provide a viable circulatory support system in patients with prolonged cardiac arrest who fail conventional resuscitation techniques. ECMO is also an effective means of support as a mechanical bridge to heart transplantation.