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Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in pediatric cardiac support.
Ann Thorac Surg. 2006 Jul; 82(1):138-44; discussion 144-5.AT

Abstract

BACKGROUND

Resuscitation extracorporeal membrane oxygenation (R-ECMO) was introduced at our institution in July 2002. We reviewed the use of venoarterial (VA)-ECMO for cardiac diagnoses at our institution.

METHODS

Retrospective analysis of patients on VA-ECMO for cardiac failure was performed. Survival was defined as discharge from hospital.

RESULTS

Twenty-seven patients were supported with VA-ECMO (median age, 27 days; range, 1 to 640 days; median weight, 3.8 kg; range, 1.8 to 11.3 kg). Diagnoses were cardiomyopathy-myocarditis (CMM) in 8 (30%), systemic-to-pulmonary artery shunt-dependent single ventricle (SV) in 12 (44%), postcardiotomy for biventricular repair (BiV) in 6 (22%), and arrhythmia in 1 (4%). Sixteen of 27 patients survived (59%). Seven of 8 CMM patients survived (88%); 6 (75%) bridged to cardiac recovery, 1 to transplant (13%), and 1 death (13%). Seven of 12 SV patients survived (58%). The SV ECMO indications: post-Norwood ventricular dysfunction (n = 3, 2 deaths), postoperative cardiac failure (n = 6, 2 deaths), respiratory failure (n = 1, 1 death), and acute shunt occlusion (n = 2, 0 deaths). One of 6 BiV patients survived (17%). The BiV ECMO indications: failure to wean from CPB (n = 3, 3 deaths), postoperative cardiac failure (n = 2, 2 deaths), and pulmonary hypertension (n = 1, 0 deaths). Fifteen patients (56%) underwent cardiopulmonary resuscitation during ECMO cannulation. Eleven of 15 R-ECMO patients (73%) survived versus 5 of 12 non-R-ECMO patients (42%, p = 0.13). Median duration of R-ECMO: 66 hours (range, 18 to 179) versus 145 hours (range, 43 to 986, p = 0.01) for non-R-ECMO.

CONCLUSIONS

Resuscitation extracorporeal membrane oxygenation is an appropriate application in pediatric patients with cardiac disease. Single ventricle patients experiencing cardiopulmonary collapse and CMM patients have favorable outcomes. Failure to wean from CPB and postoperative ventricular failure are higher risk indications.

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Authors+Show Affiliations

Thourani VH
Joseph B. Whitehead Department of Surgery, Section of Pediatric Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Kirshbom PM
No affiliation info available
Kanter KR
No affiliation info available
Simsic J
No affiliation info available
Kogon BE
No affiliation info available
Wagoner S
No affiliation info available
Dykes F
No affiliation info available
Fortenberry J
No affiliation info available
Forbess JM
No affiliation info available

MeSH

Cardiac Surgical ProceduresCardiopulmonary ResuscitationExtracorporeal Membrane OxygenationFemaleFollow-Up StudiesHeart Defects, CongenitalHeart FailureHeart TransplantationHeart VentriclesHumansHypertension, PulmonaryInfantInfant, NewbornMaleMyocarditisRetrospective StudiesSurvival RateWaiting Lists

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16798204

Citation

Thourani, Vinod H., et al. "Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) in Pediatric Cardiac Support." The Annals of Thoracic Surgery, vol. 82, no. 1, 2006, pp. 138-44; discussion 144-5.
Thourani VH, Kirshbom PM, Kanter KR, et al. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in pediatric cardiac support. Ann Thorac Surg. 2006;82(1):138-44; discussion 144-5.
Thourani, V. H., Kirshbom, P. M., Kanter, K. R., Simsic, J., Kogon, B. E., Wagoner, S., Dykes, F., Fortenberry, J., & Forbess, J. M. (2006). Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in pediatric cardiac support. The Annals of Thoracic Surgery, 82(1), 138-44; discussion 144-5.
Thourani VH, et al. Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) in Pediatric Cardiac Support. Ann Thorac Surg. 2006;82(1):138-44; discussion 144-5. PubMed PMID: 16798204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in pediatric cardiac support. AU - Thourani,Vinod H, AU - Kirshbom,Paul M, AU - Kanter,Kirk R, AU - Simsic,Janet, AU - Kogon,Brian E, AU - Wagoner,Scott, AU - Dykes,Francine, AU - Fortenberry,James, AU - Forbess,Joseph M, PY - 2004/11/08/received PY - 2006/01/26/revised PY - 2006/02/04/accepted PY - 2006/6/27/pubmed PY - 2006/8/15/medline PY - 2006/6/27/entrez SP - 138-44; discussion 144-5 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 82 IS - 1 N2 - BACKGROUND: Resuscitation extracorporeal membrane oxygenation (R-ECMO) was introduced at our institution in July 2002. We reviewed the use of venoarterial (VA)-ECMO for cardiac diagnoses at our institution. METHODS: Retrospective analysis of patients on VA-ECMO for cardiac failure was performed. Survival was defined as discharge from hospital. RESULTS: Twenty-seven patients were supported with VA-ECMO (median age, 27 days; range, 1 to 640 days; median weight, 3.8 kg; range, 1.8 to 11.3 kg). Diagnoses were cardiomyopathy-myocarditis (CMM) in 8 (30%), systemic-to-pulmonary artery shunt-dependent single ventricle (SV) in 12 (44%), postcardiotomy for biventricular repair (BiV) in 6 (22%), and arrhythmia in 1 (4%). Sixteen of 27 patients survived (59%). Seven of 8 CMM patients survived (88%); 6 (75%) bridged to cardiac recovery, 1 to transplant (13%), and 1 death (13%). Seven of 12 SV patients survived (58%). The SV ECMO indications: post-Norwood ventricular dysfunction (n = 3, 2 deaths), postoperative cardiac failure (n = 6, 2 deaths), respiratory failure (n = 1, 1 death), and acute shunt occlusion (n = 2, 0 deaths). One of 6 BiV patients survived (17%). The BiV ECMO indications: failure to wean from CPB (n = 3, 3 deaths), postoperative cardiac failure (n = 2, 2 deaths), and pulmonary hypertension (n = 1, 0 deaths). Fifteen patients (56%) underwent cardiopulmonary resuscitation during ECMO cannulation. Eleven of 15 R-ECMO patients (73%) survived versus 5 of 12 non-R-ECMO patients (42%, p = 0.13). Median duration of R-ECMO: 66 hours (range, 18 to 179) versus 145 hours (range, 43 to 986, p = 0.01) for non-R-ECMO. CONCLUSIONS: Resuscitation extracorporeal membrane oxygenation is an appropriate application in pediatric patients with cardiac disease. Single ventricle patients experiencing cardiopulmonary collapse and CMM patients have favorable outcomes. Failure to wean from CPB and postoperative ventricular failure are higher risk indications. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/16798204/Venoarterial_extracorporeal_membrane_oxygenation__VA_ECMO__in_pediatric_cardiac_support_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)00235-9 DB - PRIME DP - Unbound Medicine ER -