Extracorporeal Membrane Oxygenation in Postcardiotomy Pediatric Patients—15 Years of Experience Outside Europe and North America

Abstract

Background The increasing complexity of congenital cardiac surgery has resulted in the increased use of extracorporeal membrane oxygenation (ECMO) support for children who cannot be weaned from cardiopulmonary bypass. The purpose of this research was to assess the mortality and morbidity in children requiring ECMO support after the repair of congenital heart defects (CHDs).

Methods The hospital records of all patients with CHD who required ECMO after a cardiac surgical procedure between January 2001 and December 2016 were retrospectively reviewed. Various outcomes were reported and tested for any association with hospital death.

Results A total of 113 children required ECMO for cardiopulmonary support after congenital cardiac surgery; 88 (77.9%) were placed on ECMO in the operating room. Median age of the patients was 3 months (range, 4 days–15 years) and median weight was 3.5 kg (range, 2.2–42.5). Forty-two (37.2%) survived to hospital discharge. In children with single-ventricle physiology, survival to discharge was 37.3% (19/51 patients) and for biventricular physiology, it was 37.1% (23/62 patients). Univariate analysis revealed number of days on ECMO support, renal failure, and stroke as risk factors for hospital mortality, while age and cross-clamp time were found to be statistically nonsignificant.

Conclusion Satisfactory results can be achieved in pediatric patients by using ECMO support for postoperative cardiac and pulmonary failure refractory to medical management. Prolonged ECMO support, renal failure, and stroke are risk of mortality.

Keywords

extracorporeal membrane oxygenation - congenital heart disease - pediatric - cardiac surgery

• References

• 1 Ghez O, Feier H, Ughetto F, Fraisse A, Kreitmann B, Metras D. Postoperative extracorporeal life support in pediatric cardiac surgery: recent results. ASAIO J 2005; 51 (05) 513-516
• 2 Fenton KN, Webber SA, Danford DA, Gandhi SK, Periera J, Pigula FA. Long-term survival after pediatric cardiac transplantation and postoperative ECMO support. Ann Thorac Surg 2003; 76 (03) 843-846 , discussion 847
• 3 Bartlett RH. Extracorporeal life support: history and new directions. ASAIO J 2005; 51 (05) 487-489
• 4 Shah SA, Shankar V, Churchwell KB. , et al. Clinical outcomes of 84 children with congenital heart disease managed with extracorporeal membrane oxygenation after cardiac surgery. ASAIO J 2005; 51 (05) 504-507
• 5 Aharon AS, Drinkwater Jr DC, Churchwell KB. , et al. Extracorporeal membrane oxygenation in children after repair of congenital cardiac lesions. Ann Thorac Surg 2001; 72 (06) 2095-2101 , discussion 2101–2102
• 6 del Nido PJ. Extracorporeal membrane oxygenation for cardiac support in children. Ann Thorac Surg 1996; 61 (01) 336-339 , discussion 340–341
• 7 Mehta U, Laks H, Sadeghi A. , et al. Extracorporeal membrane oxygenation for cardiac support in pediatric patients. Am Surg 2000; 66 (09) 879-886
• 8 Hetzer R, Stiller B. Technology insight: use of ventricular assist devices in children. Nat Clin Pract Cardiovasc Med 2006; 3 (07) 377-386
• 9 Duncan BW. Pediatric mechanical circulatory support in the United States: past, present, and future. ASAIO J 2006; 52 (05) 525-529
• 10 Duncan BW. Mechanical cardiac support in the young. Short-term support: ECMO. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006; 9: 75-82
• 11 Kulik TJ, Moler FW, Palmisano JM. , et al. Outcome-associated factors in pediatric patients treated with extracorporeal membrane oxygenator after cardiac surgery. Circulation 1996; 94 (9, Suppl): II63-II68
• 12 Langley SM, Sheppard SV, Tsang VT, Monro JL, Lamb RK. When is extracorporeal life support worthwhile following repair of congenital heart disease in children?. Eur J Cardiothorac Surg 1998; 13 (05) 520-525
• 13 Jaggers JJ, Forbess JM, Shah AS. , et al. Extracorporeal membrane oxygenation for infant postcardiotomy support: significance of shunt management. Ann Thorac Surg 2000; 69 (05) 1476-1483
• 14 Hoskote A, Bohn D, Gruenwald C. , et al. Extracorporeal life support after staged palliation of a functional single ventricle: subsequent morbidity and survival. J Thorac Cardiovasc Surg 2006; 131 (05) 1114-1121
• 15 Chan T, Thiagarajan RR, Frank D, Bratton SL. Survival after extracorporeal cardiopulmonary resuscitation in infants and children with heart disease. J Thorac Cardiovasc Surg 2008; 136 (04) 984-992
• 16 Alsoufi B, Al-Radi OO, Gruenwald C. , et al. Extra-corporeal life support following cardiac surgery in children: analysis of risk factors and survival in a single institution. Eur J Cardiothorac Surg 2009; 35 (06) 1004-1011 , discussion 1011
• 17 Lequier L. Extracorporeal life support in pediatric and neonatal critical care: a review. J Intensive Care Med 2004; 19 (05) 243-258
• 18 Extracorporeal Life Support Organization. ECLS Registry Report: International Summary. Ann Arbor, MI, Extracorporeal Life Support Organization, 2016, pp 24–72. Available at: https://www.elso.org/Registry/Statistics/InternationalSummary.aspx . Accessed 2017
• 19 Sasaki T, Asou T, Takeda Y, Onakatomi Y, Tominaga T, Yamamoto Y. Extracorporeal life support after cardiac surgery in children: outcomes from a single institution. Artif Organs 2014; 38 (01) 34-40
• 20 Roeleveld PP. What is new in pediatric ECMO? 2016, a year in review. Eur J Heart Fail 2017; 19 (Suppl. 02) 92-96
• 21 Flórez CX, Bermon A, Castillo VR, Salazar L. Setting up an ECMO program in a South American country: outcomes of the first 104 pediatric patients. World J Pediatr Congenit Heart Surg 2015; 6 (03) 374-381
• 22 Thourani VH, Kirshbom PM, Kanter KR. , et al. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in pediatric cardiac support. Ann Thorac Surg 2006; 82 (01) 138-144 , discussion 144–145
• 23 Horne D, Conway J, Rebeyka IM, Buchholz H. Mechanical circulatory support in univentricular hearts: current management. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2015; 18 (01) 17-24
• 24 Thiagarajan RR, Laussen PC, Rycus PT, Bartlett RH, Bratton SL. Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation 2007; 116 (15) 1693-1700
• 25 Mascio CE, Austin III EH, Jacobs JP. , et al. Perioperative mechanical circulatory support in children: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2014; 147 (02) 658-664 , discussion 664–665
• 26 Ungerleider RM, Shen I, Yeh T. , et al. Routine mechanical ventricular assist following the Norwood procedure–improved neurologic outcome and excellent hospital survival. Ann Thorac Surg 2004; 77 (01) 18-22
• 27 Delmo Walter EM, Alexi-Meskishvili V, Huebler M. , et al. Extracorporeal membrane oxygenation for intraoperative cardiac support in children with congenital heart disease. Interact Cardiovasc Thorac Surg 2010; 10 (05) 753-758
• 28 Walters III HL, Hakimi M, Rice MD, Lyons JM, Whittlesey GC, Klein MD. Pediatric cardiac surgical ECMO: multivariate analysis of risk factors for hospital death. Ann Thorac Surg 1995; 60 (02) 329-336 , discussion 336–337
• 29 Chaturvedi RR, Macrae D, Brown KL. , et al. Cardiac ECMO for biventricular hearts after paediatric open heart surgery. Heart 2004; 90 (05) 545-551
• 30 Misfeldt AM, Kirsch RE, Goldberg DJ. , et al. Outcomes of single-ventricle patients supported with extracorporeal membrane oxygenation. Pediatr Crit Care Med 2016; 17 (03) 194-202
• 31 Kolovos NS, Bratton SL, Moler FW. , et al. Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery. Ann Thorac Surg 2003; 76 (05) 1435-1441 , discussion 1441–1442
• 32 Wolf MJ, Kanter KR, Kirshbom PM, Kogon BE, Wagoner SF. Extracorporeal cardiopulmonary resuscitation for pediatric cardiac patients. Ann Thorac Surg 2012; 94 (03) 874-879 , discussion 879–880
• 33 Philip J, Burgman C, Bavare A. , et al. Nature of the underlying heart disease affects survival in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation. J Thorac Cardiovasc Surg 2014; 148 (05) 2367-2372
• 34 Sherwin ED, Gauvreau K, Scheurer MA. , et al. Extracorporeal membrane oxygenation after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2012; 144 (06) 1337-1343
• 35 Jolley M, Thiagarajan RR, Barrett CS. , et al. Extracorporeal membrane oxygenation in patients undergoing superior cavopulmonary anastomosis. J Thorac Cardiovasc Surg 2014; 148 (04) 1512-1518
• 36 Rood KL, Teele SA, Barrett CS. , et al. Extracorporeal membrane oxygenation support after the Fontan operation. J Thorac Cardiovasc Surg 2011; 142 (03) 504-510
• 37 Black MD, Coles JG, Williams WG. , et al. Determinants of success in pediatric cardiac patients undergoing extracorporeal membrane oxygenation. Ann Thorac Surg 1995; 60 (01) 133-138
• 38 Fleming GM, Sahay R, Zappitelli M. , et al. The incidence of acute kidney injury and its effect on neonatal and pediatric extracorporeal membrane oxygenation outcomes: a multicenter report from the Kidney Intervention During Extracorporeal Membrane Oxygenation Study Group. Pediatr Crit Care Med 2016; 17 (12) 1157-1169