Efficacy of Extracorporeal Membrane Oxygenation in a Congenital Heart Surgery Program

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2007 Jan 18

PMID 17225914

Citations 2

Authors

Jorg S Sachweh

Andreas R Tiete

Alexandra Fuchs

Ulrich Romer

Reiner Kozlik-Feldmann

Bruno Reichart

Sabine H Dabritz

Affiliations

Soon will be listed here.

Abstract

Background: To report our experience with extracorporeal membrane oxygenation (ECMO) in a congenital heart surgery program.

Methods: Since 12/1996, 24 patients (8 newborns, 9 infants, 3 children, 4 adolescents/ adults 17-23 years), mean age 4.0+/-7.4 years (2 days-23 years), body weight 2.7-87 kg had ECMO as circulatory support. Indication was failure to wean from cardiopulmonary bypass in the majority of cases.

Results: Mean duration of support was 3.8+/-2.9 d (12 h-13 d). Fourteen patients were weaned from ECMO (9 discharged), three successfully transplanted (one after switching to a pulsatile assist device). One patient on left-ventricular support required ECMO for sudden right ventricular failure (decreased). There were six deaths on ECMO due to multiorgan failure (MOV) (3) or no myocardial recovery (3). Six patients died after weaning (3 MOV, 2 myocardial failure, 1 fungal sepsis). Overall, twelve patients (50%) were discharged and are clinically well after 3.4+/-2.4 years (0.8-7.2 years).

Conclusion: In our series, ECMO markedly reduces mortality in patients who would otherwise not survive either open heart surgery or myocardial failure of any origin and was not associated with discernible morbidity in the midterm.

Citing Articles

ECMO for Cardiac Rescue after Accidental Intravenous Mepivacaine Application.

Froehle M, Haas N, Kirchner G, Kececioglu D, Sandica E Case Rep Pediatr. 2012; 2012:491692.

PMID: 22966472 PMC: 3433119. DOI: 10.1155/2012/491692.

ECMO for cardiac rescue in a neonate with accidental amiodarone overdose.

Haas N, Wegendt C, Schaffler R, Kirchner G, Welisch E, Kind K Clin Res Cardiol. 2008; 97(12):878-81.

PMID: 18712427 DOI: 10.1007/s00392-008-0700-7.

References

Montgomery V, Strotman J, Ross M . Impact of multiple organ system dysfunction and nosocomial infections on survival of children treated with extracorporeal membrane oxygenation after heart surgery. Crit Care Med. 2000; 28(2):526-31. DOI: 10.1097/00003246-200002000-00040. View

Duncan B, Ibrahim A, Hraska V, Del Nido P, Laussen P, Wessel D . Use of rapid-deployment extracorporeal membrane oxygenation for the resuscitation of pediatric patients with heart disease after cardiac arrest. J Thorac Cardiovasc Surg. 1998; 116(2):305-11. DOI: 10.1016/s0022-5223(98)70131-x. View

Morris M, Ittenbach R, Godinez R, Portnoy J, Tabbutt S, Hanna B . Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation. Crit Care Med. 2004; 32(4):1061-9. DOI: 10.1097/01.ccm.0000119425.04364.cf. View

BAFFES T, Fridman J, BICOFF J, WHITEHILL J . Extracorporeal circulation for support of palliative cardiac surgery in infants. Ann Thorac Surg. 1970; 10(4):354-63. DOI: 10.1016/s0003-4975(10)65613-5. View

Ibrahim A, Duncan B, Blume E, Jonas R . Long-term follow-up of pediatric cardiac patients requiring mechanical circulatory support. Ann Thorac Surg. 2000; 69(1):186-92. DOI: 10.1016/s0003-4975(99)01194-7. View

Kliegman R . The relationship of neonatal feeding practices and the pathogenesis and prevention of necrotizing enterocolitis. Pediatrics. 2003; 111(3):671-2. DOI: 10.1542/peds.111.3.671. View

Del Nido P . Extracorporeal membrane oxygenation for cardiac support in children. Ann Thorac Surg. 1996; 61(1):336-9; discussion 340-1. DOI: 10.1016/0003-4975(95)01019-X. View

Kolovos N, Bratton S, Moler F, Bove E, Ohye R, Bartlett R . Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery. Ann Thorac Surg. 2003; 76(5):1435-41. DOI: 10.1016/s0003-4975(03)00898-1. View

Walters 3rd H, Hakimi M, Rice M, Lyons J, Whittlesey G, Klein M . Pediatric cardiac surgical ECMO: multivariate analysis of risk factors for hospital death. Ann Thorac Surg. 1995; 60(2):329-36; discussion 336-7. DOI: 10.1016/0003-4975(95)00410-m. View

10.

Duncan B, Hraska V, Jonas R, Wessel D, Del Nido P, Laussen P . Mechanical circulatory support in children with cardiac disease. J Thorac Cardiovasc Surg. 1999; 117(3):529-42. DOI: 10.1016/s0022-5223(99)70333-8. View

11.

Kihara S, Kawai A, Endo M, Koyanagi H, Kurosawa H . Extracorporeal membrane oxygenation and left ventricular assist device: a case of double mechanical bridge. Heart Vessels. 2002; 16(4):164-6. DOI: 10.1007/s003800200015. View

12.

Jaggers J, Forbess J, Shah A, Meliones J, Kirshbom P, Miller C . Extracorporeal membrane oxygenation for infant postcardiotomy support: significance of shunt management. Ann Thorac Surg. 2000; 69(5):1476-83. DOI: 10.1016/s0003-4975(00)01330-8. View

13.

Chaturvedi R, Macrae D, Brown K, Schindler M, Smith E, Davis K . Cardiac ECMO for biventricular hearts after paediatric open heart surgery. Heart. 2004; 90(5):545-51. PMC: 1768194. DOI: 10.1136/hrt.2002.003509. View

14.

. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; 346(8):549-56. DOI: 10.1056/NEJMoa012689. View

15.

Aharon A, Drinkwater Jr D, Churchwell K, Quisling S, Reddy V, Taylor M . Extracorporeal membrane oxygenation in children after repair of congenital cardiac lesions. Ann Thorac Surg. 2002; 72(6):2095-101; discussion 2101-2. DOI: 10.1016/s0003-4975(01)03209-x. View

16.

Kulik T, Moler F, Palmisano J, Custer J, Mosca R, Bove E . Outcome-associated factors in pediatric patients treated with extracorporeal membrane oxygenator after cardiac surgery. Circulation. 1996; 94(9 Suppl):II63-8. View

17.

Hadem J, Schroder F, Winkler T, Gohrbandt B, Fischer D, Korte T . One day from dyspnea to death--unsuccessful application of extracorporeal membrane oxygenation in toxoplasma myocarditis following bone marrow transplantation. Clin Res Cardiol. 2006; 95(9):477-81. DOI: 10.1007/s00392-006-0402-y. View