Clinical Outcomes of 84 Children with Congenital Heart Disease Managed with Extracorporeal Membrane Oxygenation after Cardiac Surgery

Clinical Outcomes of 84 Children with Congenital Heart Disease Managed with Extracorporeal Membrane Oxygenation after Cardiac Surgery

The purpose of our research was to study the clinical outcomes of children with congenital heart disease (CHD) requiring extracorporeal membrane oxygenation (ECMO) support after cardiac surgery at a tertiary care childrenʼs hospital. Retrospective review of all patients with CHD who required postcar...

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Bibliographic Details
Published in:ASAIO journal (1992) Vol. 51; no. 5; pp. 504 - 507
Main Authors: Shah, Salman A, Shankar, V, Churchwell, Kevin B, Taylor, Mary B, Scott, B P, Bartilson, Randall, Byrne, Dan W, Christian, Karla G, Drinkwater, Davis C
Format: Journal Article
Language:English
Published: United States Copyright by the American Society for Artificial Internal Organs 01-09-2005
Subjects:
Cardiopulmonary Resuscitation
Chi-Square Distribution
Child
Child, Preschool
Extracorporeal Membrane Oxygenation
Female
Heart Arrest - therapy
Heart Defects, Congenital - therapy
Hospital Mortality
Humans
Male
Retrospective Studies
Survival Rate
Thoracic Surgery
Time Factors
Treatment Outcome
United States
United States
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Summary:The purpose of our research was to study the clinical outcomes of children with congenital heart disease (CHD) requiring extracorporeal membrane oxygenation (ECMO) support after cardiac surgery at a tertiary care childrenʼs hospital. Retrospective review of all patients with CHD who required postcardiotomy ECMO between January 2001 and September 2004 (45 months) was undertaken. Various outcome predictors were tested for any association with survival to hospital discharge using univariate analysis. A total of 84 children were placed on ECMO after CHD surgery; 39 (46.4%) were placed on ECMO in the operating room. Median age of the patients was 128 days (1 day to 5 years) and median weight was 4.53 kg (2–18 kg). Active cardiopulmonary resuscitation was ongoing at the time of cannulation in 27 children (32%). Fifty-two children (61.9) survived > 24 hours after decannulation and 31 (36.9%) survived to discharge. High arterial serum lactate levels at the time of ECMO initiation were strongly correlated with nonsurvival (p = 0.004). Nonsurvivors had longer duration on ECMO than survivors (p = 0.003). The odds of survival dropped significantly after 144 hours (day 6) of ECMO. ECMO support results in improved outcomes in patients who suffered hemodynamic collapse post cardiac surgery. Underlying cardiac lesion, age, weight, gender, initial arterial pH, location of ECMO initiation, need for hemofiltration and placement of ECMO after active ongoing cardiopulmonary resuscitation did not increase the mortality risk. Initial arterial serum lactate level and inability to wean off by 6 days were strongly correlated with nonsurvival.
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ISSN:1058-2916
1538-943X
DOI:10.1097/01.mat.0000171595.67127.74