Extracorporeal membrane oxygenation for cardiac support in children

doi:10.1016/0003-4975(95)01019-X

The Annals of Thoracic Surgery

Volume 61, Issue 1, January 1996, Pages 336-339

https://doi.org/10.1016/0003-4975(95)01019-X Get rights and content

Background.

Extracorporeal membrane oxygenation (ECMO) support for cardiac failure has been used in children since 1981 at the Children's Hospital in Pittsburgh. Most children required support after cardiac operations. Recently, however, a larger number of patients with decompensated cardiomyopathy or myocarditis have been supported with ECMO, which was used as a bridge to transplantation in most.

Methods.

From 1981 to 1994, 68 children were placed on ECMO for cardiac support.

Results.

The overall survival for the entire time period was 38%, with the more recent experience survival increased to 47%. In 14 children, ECMO was used as a bridge to transplantation, with 9 children receiving a heart transplant and 7 long-term survivors. Extracorporeal membrane oxygenation has also been used to resuscitate 11 children after sudden cardiac arrest, with a long-term survival of 53%.

Conclusions.

We conclude that ECMO support for severe cardiac failure is effective. Patient selection and the use of heart transplantation for intractable heart failure have improved the overall survival.

References (10)

DeliusRE et al.
Prolonged extracorporeal life support of pediatric and adolescent cardiac transplant patients
Ann Thorac Surg
(1990)
PenningtonDG et al.
Circulatory support in infants and children
Ann Thorac Surg
(1993)
KarlTR et al.
Centrifugal pump left heart assist in pediatric cardiac operations: indications, techniques and results
J Thorac Cardiovasc Surg
(1991)
LouisPT et al.
Nonpulsatile total left ventricular support in pediatric patients
Crit Care Med
(1992)
JettGK et al.
Circulatory support for right ventricular dysfunction
J Thorac Cardiovasc Surg
(1987)

There are more references available in the full text version of this article.

Cited by (125)

Extracorporeal membrane oxygenation post-cardiotomy in the pediatric age: 119 patients in 20 years of experience
2019, Cirugia Cardiovascular
Un porcentaje de pacientes intervenidos de cirugía cardiaca presentan fracaso cardiorrespiratorio refractario a medidas convencionales, y precisan soporte circulatorio y respiratorio con membrana de oxigenación extracorpórea (ECMO) en el postoperatorio.
En los últimos 20 años, 119 pacientes pediátricos precisaron ECMO en nuestro centro.
El 46% de los pacientes fueron neonatos, con una edad media de 15,4 meses y un peso de 6,9 kg.
La principal indicación (60%) fue incapacidad de destete de la circulación extracorpórea.
De los 119 pacientes intervenidos se consiguió un éxito de destete en el 63%, con un porcentaje de supervivencia del 50%. A partir del año 2009, se consigue el destete en el 78% de los pacientes, con supervivencia del 66%.
Los factores de riesgo asociados con mortalidad en el análisis univariante fueron: sexo masculino, periodo neonatal, la primera etapa (antes de 2009), cardioplejía St. Thomas, tiempo de circulación extracorpórea, no drenaje de cavidades izquierdas, duración de la ECMO menos de 2 días o más de 5, y el uso de dispositivo diferente de la centrífuga de segunda generación.
El 47% de los pacientes necesitaron algún tipo de reintervención.
Se trata de una serie amplia de ECMO poscardiotomía en la edad pediátrica, con buenos resultados de destete y supervivencia, especialmente en la última década (66% de supervivencia).
La mitad de los pacientes necesitaron algún tipo de reintervención, por lo que es muy importante la búsqueda de lesiones residuales postoperatorias.
A percentage of patients undergoing cardiac surgery present with cardiorespiratory failure refractory to maximal conventional therapy during the post-operative period, and require circulatory and respiratory support with extracorporeal membrane oxygenation (ECMO).
A total of 119 paediatric patients required ECMO after cardiotomy in our institution.
Just under half (46%) of the patients were neonates, with a mean age of 15.4 months and mean weight of 6.9 kg.
The main indication (60%) was the impossibility to wean the patient off extracorporeal circulation.
Of the 119 patients, weaning off ECMO was achieved in 63%, with a survival rate of 50%. As of 2009, weaning rate was 78%, with 66% survival.
The risk factors associated with mortality in the univariate analysis were: male gender, neonatal period, and the first era (before 2009), as well as St. Thomas Cardioplegia, extracorporeal circulation time, no left cavities drainage, ECMO duration of less than two days or more than 5, and the use of a device different from the second generation centrifuge pump.
Just under half (47%) of the patients needed some type of re-intervention.
This is a wide series of post-cardiotomy ECMO in patients of paediatric age, with good weaning and survival results, especially in the last decade (66% survival).
Some type of re-intervention was required by 47% of the patients, making it very important to look actively for residual post-operative residual lesions.
Anesthesia for Congenital Heart Surgery
2016, Smith's Anesthesia for Infants and Children, Ninth Edition
Prognostic markers of mortality after congenital heart defect surgery
2012, Anales de Pediatria
Identificar los factores de riesgo de mortalidad postoperatoria para establecer indicaciones de oxigenación con membrana extracorpórea en niños cardiópatas.
Entre abril del 2007 y junio del 2009 fueron intervenidos 186 niños con circulación extracorpórea. Se determinaron en sangre arterial y venosa, al ingreso en UCIP y a las 22 horas, el pH, la pCO₂, la SatO₂ y el exceso base, y el CO₂ en aire espirado. El lactato se midió en quirófano, al ingreso en UCIP y durante el postoperatorio, para determinar el tiempo en que se mantuvo elevado, su pico máximo, y la velocidad de variación. Se calculó además, la diferencia arteriovenosa de la saturación de oxígeno, su extracción tisular, la fracción de espacio muerto y el shunt intrapulmonar.
La mortalidad hospitalaria fue del 13,4%. Se identificaron como factores de riesgo de mortalidad, la edad, el tiempo de extracorpórea, el score inotrópico; el lactato al ingreso, su pico máximo, la velocidad de variación y el tiempo en que estuvo elevado; la saturación venosa, el exceso de base, el espacio muerto, la extracción de oxígeno, y el shunt intrapulmonar. Las variables que mostraron mayor valor predictivo de mortalidad fueron el tiempo de extracorpórea, el lactato al ingreso y su pico máximo. En el análisis multivariante se detectaron como variables independientes de mortalidad, un pico de lactato de 6,3 mmol/l y un tiempo hiperlactacidemia de 24 h.
La elevación máxima del lactato posee una alta capacidad predictiva de mortalidad y nos permitirá iniciar precozmente la oxigenación con membrana extracorpórea.
Our aim is to identify risk factors for mortality after surgery for congenital heart disease in children, in order to establish indications for extracorporeal membrane oxygenation (ECMO).
One hundred and eighty six children underwent cardiac surgery with extracorporeal circulation from April 2007 to June 2009. The following parameters were measured serially during their stay in Paediatric Intensive Care (PICU): Arterial and venous blood pH, pCO2, base excess, oxygen saturation, arterio-venous oxygen saturation difference, oxygen extraction ratio, ventilatory dead space and intrapulmonary shunting.
Hospital mortality was 13,4%. The following risk factors for mortality were identified: age, bypass time, inotropic score, lactate level upon arrival in PICU including its peak value and its rate of variation, mixed venous saturation, base excess, ventilatory dead space, oxygen extraction ratio, and intrapulmonary shunting. However, the strongest predictors of mortality were bypass time, lactate levels upon admission on PICU, and the peak lactate level. Multivariate analysis showed a lactate level of 6.3 mmol/l and a high blood lactate for 24 hours to be independent predictors of mortality.
The peak lactate level is a strong predictor of mortality. As such, it would be a useful indicator of the need for ECMO support.
Extracorporeal cardiopulmonary resuscitation for pediatric cardiac patients
2012, Annals of Thoracic Surgery
Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve survival after in-hospital pediatric cardiac arrest. We describe our experience with ECPR for refractory cardiac arrest in pediatric cardiac patients.
We performed a retrospective analysis of the use of venoarterial extracorporeal membrane oxygenation (ECMO) for in-hospital cardiac arrest from 2002 to 2011. The primary endpoint was survival to discharge, and the secondary endpoint was long-term functional neurologic status.
Of 160 total uses of cardiac ECMO in 159 patients, 90 (56%) were ECPR (mean age 2.05 years; range, 0 days to 16.5 years). Sixty-four patients (71%) were postoperative, of which 36 were single ventricle and 28 were biventricular. Nine patients (10%) had cardiomyopathy-myocarditis, and 17 patients (19%) were nonpostoperative (5 single ventricle; 12 biventricular). Fifty-nine patients (66%) had open chest cannulation, and 31 (34%) had peripheral cannulation. Fifty patients (56%) survived to discharge. Duration of ECMO was 4.3 ± 4.0 days (median 3) for survivors and 6.3 ± 5.4 days (median 5) for nonsurvivors (p < 0.05). On follow-up, almost half of survivors without genetic syndromes had normal neurologic status.
Extracorporeal cardiopulmonary resuscitation is an appropriate application of ECMO in pediatric cardiac patients. We report overall survival of 56%. Cardiomyopathy patients have favorable outcomes (89% survival). Biventricular patients have better outcomes then single ventricle patients (p < 0.01). Extracorporeal cardiopulmonary resuscitation also seems to be a good strategy for nonpostoperative patients (71% survival). Nearly half of postoperative patients (46%) resuscitated with ECPR survived to hospital discharge.
Devices used in cardiac arrest
2012, Emergency Medicine Clinics of North America
Citation Excerpt :
The extracorporeal membrane oxygenation (ECMO) device has shown to be effective in the neonatal population for respiratory failure56 and congenital cardiac defects.57 More recently, ECMO has been studied in chidren and adults with prolonged arrest after conventional measures have failed.58–61 A basic ECMO circuit consists of a gas-exchange device, such as an oxygenator; vascular cannulae to access and return blood; circuit tubing; a pump; and a heater–cooler that regulates blood temperature.62
Extracorporeal membranous oxygenation and left atrial decompression: A fast and minimally invasive approach
2011, Annals of Thoracic Surgery

View all citing articles on Scopus

View full text

Extracorporeal membrane oxygenation for cardiac support in children

Background.

Methods.

Results.

Conclusions.

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Nonpulsatile total left ventricular support in pediatric patients

Crit Care Med

Circulatory support for right ventricular dysfunction

J Thorac Cardiovasc Surg