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J Thorac Cardiovasc Surg. 2013 Aug;146(2):317-25. doi: 10.1016/j.jtcvs.2012.11.014. Epub 2012 Dec 8.

Short- and intermediate-term survival after extracorporeal membrane oxygenation in children with cardiac disease.

Author information

1
Department of Critical Care Medicine, Cardiac Intensive Care Unit, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa 15224, USA. chrycx@chp.edu

Abstract

OBJECTIVES:

In children with cardiac disease, common indications for extracorporeal membrane oxygenation (ECMO) include refractory cardiopulmonary resuscitation (E-CPR), failure to separate from cardiopulmonary bypass (OR-ECMO), and low cardiac output syndrome (LCOS-ECMO). Despite established acceptance, ECMO outcomes are suboptimal with a survival between 38% and 55%. We evaluated factors associated with significantly increased survival in cardiac patients requiring ECMO.

METHODS:

We conducted a retrospective investigation of consecutive patients undergoing ECMO between 2006 and 2010. Demographic, pre-ECMO, ECMO, and post-ECMO parameters were analyzed. Neurologic outcomes were assessed with the pediatric overall performance category scale at the latest follow-up.

RESULTS:

There were 3524 admissions, 95 (3%) of which necessitated ECMO; 40 (42%) E-CPR, 31 (33%) OR-ECMO, and 24 (25%) LCOS-ECMO. The overall hospital survival was 73%. The within-groups hospital survival was 75% in E-CPR, 77% OR-ECMO and 62% LCOS-ECMO. In the multivariable logistic regression analysis, chromosomal anomalies (odds ratio [OR], 8; 95% confidence interval [CI], 2-35), single ventricle (OR ,6; 95% CI, 3-33), multiple ECMO runs (OR, 15; 95% CI, 4-42), higher 24-hour ECMO flows (OR, 8; 95% CI, 4-22), decreased lung compliance (OR, 5; 95% CI, 2-16), and need for plasma exchange (OR, 5; 95% CI, 3-18) were all significant factors associated with mortality. From the univariate analysis, a common parameter associated with mortality within all groups was intracranial hemorrhage. At 1.9 years (0.9, 2.9) of follow-up, 66% were still alive, and 89% of survivors had normal function or only mild neurodevelopmental disability.

CONCLUSIONS:

ECMO was successfully used in children with cardiac disease with 73% and 66% short- and intermediate-term survival, respectively. The majority of the survivors had normal function or only a minimal neurodevelopmental deficit.

KEYWORDS:

20; 25; 41; ACT; APTT; CI; CPB; CPR; E-CPR; ECMO; LCOS; OR; OR-ECMO; POPC; Pediatric Overall Performance Category; VAD; activated clotting time; activated partial thromboplastin time; cardiopulmonary bypass; cardiopulmonary resuscitation; confidence interval; extracorporeal membrane oxygenation; failure to separate from cardiopulmonary bypass in the operating room; low cardiac output syndrome; odds ratio; refractory cardiopulmonary resuscitation; ventricular assist device

PMID:
23228400
DOI:
10.1016/j.jtcvs.2012.11.014
[Indexed for MEDLINE]
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