Single-Center Outcome of Pediatric Extracorporeal Membrane Oxygenation

Objectives: Outcome analysis of our pediatric extracorporeal membrane oxygenation (ECMO) program.

Methods: Records of 110 patients (median age: 17 days, range: 1 – 6,478; and median weight: 3.7 kg, range: 2.1 – 61) requiring 111 ECMO runs, including 64 (57.7%) neonates, 27 (24.3%) infants, and 20 (18.0%) children between 01/2000 and 12/2012 were studied. Indications for ECMO included respiratory failure (n= 12; 10.8%), acute myocarditis (n= 3; 2.7%), hemodynamic support prior to corrective surgery (n= 4; 3.6%), or during catheter intervention (n= 1; 0.9%), and hemodynamic failure following cardiac surgery (n= 90; 81.1%).

Results: Postcardiotomy bailout ECMO was required immediately for unsuccessful weaning from bypass (n= 45), or secondarily for low cardiac output (n= 19), progressive cyanosis (n= 6), or following rapid resuscitation (n= 20). Surgery involving aortic arch repair (Norwood palliation; n= 26: 28.8%, or hypoplastic arch repair for other congenital anomalies; n= 18: 20%) required the majority of ECMO runs. Between the arbitrary observation periods of 2000 to 2006 and 2007 to 2012, weaning from ECMO and hospital survival improved significantly (47.1 vs. 71.7%; p= 0.0048, and 29.4 vs. 51.7%; p= 0.0073), respectively. Coinciding with routine perioperative near-infrared spectroscopy (NIRS) monitoring, no postoperative rapid resuscitation has been necessary in the past 2 years. Primary pulmonary ECMO outcomes were unsatisfactory (10/12 deaths).

Conclusions: Pediatric ECMO outcomes have improved in our institution over time. Postcardiotomy ECMO was most commonly associated with congenital aortic arch hypoplasia repair. Routine perioperative NIRS since 2011 seems to prevent rapid resuscitation.