DETERMINANTS OF SUCCESS IN PEDIATRIC CARDIAC PATIENTS UNDERGOING EXTRACORPOREAL MEMBRANE-OXYGENATION

Background. The purpose of this retrospective study is to determine th e possible predictors of successful cardiac recovery using extracorpor eal membrane oxygenation (ECMO) and the practical limits of ECMO suppo rt. Methods. Information was gathered on 31 consecutive children with myocardial failure who could not be resuscitated with other means and underwent ECMO at the Hospital for Sick Children before January 1994. Results. Of the children who underwent ECMO as a means of cardiac resc ue, 14/31 (45%) were weaned successfully. Two distinct groups of child ren were evident based on their initial indications for ECMO: those wh o had postcardiotomy myocardial dysfunction (n = 25) and those with ca rdiomyopathy or myocarditis (n = 6). Children with residual defects af ter cardiotomy (n = 10) did not survive ECMO. Four of the 6 children w ith cardiomyopathy or myocarditis were weaned successfully. In either group of patients ECMO support beyond 6 days failed to resuscitate the myocardium; all attempts tb violate this ''time barrier'' in our stud y inevitably failed. Conclusions. Postcardiotomy residual defects are a contraindication to ECMO. If children with residual defects are excl uded, successful weaning from ECMO fan be achieved in almost 70%, with almost all recovery occurring with the first 6 days of ECMO.