EXTRACORPOREAL MEMBRANE-OXYGENATION FOR CARDIAC RESCUE IN CHILDREN WITH SEVERE MYOCARDIAL DYSFUNCTION

Objective: To assess the experience and efficacy of extracorporeal mem brane oxygenation (ECMO) for cardiac rescue in patients with presumpti vely lethal cardiac dysfunction at the Children's Hospital of Pittsbur gh. Design: Retrospective analysis of patient records from a 9-yr peri od. Setting. A 22-bed tertiary care pediatric intensive care unit (ICU ) with an average of 1,400 admissions per year. An average of 150 open cardiotomy surgeries are performed per year, and all postoperative an d severely ill cardiac patients are cared for in the ICU. Patients: A total of 29 pediatric ICU patients with myocardial failure received EC MO throughout the 9-yr study period. Interventions. None. Measurements and Main Results: Demographic information, underlying cardiac defect, intraoperative and postoperative data, postoperative course, details of ECMO treatment, and outcome were collected. Comparison of survivors with nonsurvivors was performed using the Mann-Whitney U test for con tinuous variables. Twenty-three (79%) of 29 patients recovered myocard ial function while undergoing ECMO, 18 (62%) of 29 patients were succe ssfully decannulated, and 13 (45%) of 29 patients survived to hospital discharge. Long-term survival rate was 11 (38%) of 29 patients. Three (60%) of five bridge-to-heart transplant patients survived. Eleven (6 5%) of 17 patients who suffered cardiac arrest before ECMO, survived t o discharge and nine (53%) of these 17 patients remain long-term survi vors. Survival rate in patients who required cardiac massage for >15 m ins before cannulation was six (55%) of 11 patients. Conclusions. Pati ents with severe myocardial dysfunction who fail conventional therapy can be successfully supported with ECMO during the period of myocardia l recovery. ECMO can also provide a viable circulatory support system in patients with prolonged cardiac arrest who fail conventional resusc itation techniques. ECMO is also an effective means of support as a me chanical bridge to heart transplantation.