OUTCOME-ASSOCIATED FACTORS IN PEDIATRIC-PATIENTS TREATED WITH EXTRACORPOREAL MEMBRANE-OXYGENATOR AFTER CARDIAC-SURGERY

Background The use of the extracorporeal membrane oxygenator (ECMO) fo r postoperative cardiac patients has not resulted in the same high suc cess rate as when ECMO is used for neonates with pulmonary hypertensio n or pulmonary failure. The reason for this is poorly understood. Meth ods and Results We analyzed retrospectively all pediatric patients pla ced on ECMO after surgery for a congenital heart lesion between 1981 a nd 1995 (n=64). Patients had a two-ventricular repair (A) or pulmonary blood how supplied by an aortopulmonary shunt (B) or by a cavopulnona ry connection (C). Indication for ECMO was unsatisfactory hemodynamics due to (1) ventricular dysfunction, (2) pulmonary failure, (3) pulmon ary hypertension, or (4) a combination or (5) for unclear reasons. Hos pital survival was related to these and other factors. Overall hospita l survival was 33%; 42% of group A patients survived to discharge, whe reas only 25% and 17% survived in groups B and C, respectively. Surviv al was unrelated to the indication for ECMO but appeared to be lower w hen ECMO was initiated in the operating room or >50 hours after surger y. Except for one patient with pneumonia, no patient survived who was on ECMO for >208 hours. ECMO discontinuation in nonsurvivors was due t o neurological (30%) or multiple complications (39%), the lack of retu rn of cardiac function (12%), or other reasons (15%). Conclusions This review suggests that the diagnosis of single ventricle, initiation of ECMO in the operating room or >50 hours after surgery, and ECMO for > 208 hours are associated with patient nonsurvival. Noncardiac complica tions more frequently led to discontinuation of ECMO than did failure of the return of cardiac function.