PEDIATRIC CARDIAC SURGICAL ECMO - MULTIVARIATE-ANALYSIS OF RISK-FACTORS FOR HOSPITAL DEATH

Background. Extracorporeal membrane oxygenation (ECMO) has emerged as an effective technique for the mechanical support of many pediatric po stcardiotomy patients with medically refractory cardiac failure. Metho ds. We retrospectively reviewed the records of 73 pediatric patients w ith congenital heart disease who were placed on ECMO support between A ugust 1984 and February 1994. The patients were divided into groups de fined by the timing of ECMO cannulation relative to the time of operat ion. Group 1 patients (n = 7,9.6%) were placed on ECMO preoperatively. Group 2 patients (n = 66, 90.4%) were a heterogeneous population plac ed on ECMO at any interval after cardiac repair. Subgroup 2A consisted of patients (n = 17, 25.8%) who could not be weaned from cardiopulmon ary bypass and were converted directly to ECMO support immediately aft er repair. Subgroup 2B patients (n = 49, 74.2%) were cannulated postop eratively after an initial period of clinical stability. Results. Hosp ital survival for all study patients (42/73) and for group 2 patients (38/66) was 58%. Only 4 group 2A patients (23.5%) survived their hospi talization compared with 34 group 2B patients (69.4%) (p = 0.001). Mul tivariate analysis identified elevated right atrial pressure after ECM O decannulation (p = 0.049) and, possibly, membership in group 2A (p = 0.061) as independent risk factors for hospital death. Conclusions. E xtracorporeal membrane oxygenation is most effective in salvaging pedi atric cardiac surgical patients who demonstrate medically refractory h emodynamic deterioration at some interval after being successfully wea ned from cardiopulmonary bypass. The right atrial pressure after extra corporeal membrane oxygenation decannulation is an independent predict or of hospital death.