WHEN IS EXTRACORPOREAL LIFE-SUPPORT WORTHWHILE FOLLOWING REPAIR OF CONGENITAL HEART-DISEASE IN CHILDREN

Background: Although the use of extracorporeal life support (ECLS) fol lowing repair of congenital heart defects in children is increasing, t he criteria for ECLS usage in these patients is not well defined. The overall survival of such patients is disappointingly low and may depen d on both the indication for support and the time at which ECLS is com menced. Methods: Between January 1993 and December 1996, 727 children underwent surgery for congenital heart defects at our institution with an overall hospital mortality of 5.8% (42 children). Nine of these ch ildren were treated with ECLS postoperatively. There were seven males and two females with a mean age of 7.2 months (range 2 weeks-3 years). Seven children could not be weaned from cardiopulmonary bypass (CPB) in the operating theatre. A further two were treated with ECLS later o n during the postoperative period (commenced at 14 and 48 h), Full ven o-arterial extra corporeal membrane oxygenation (ECMO) support was use d in all children except one in whom a left ventricular assist device (LVAD) was used. Results: The median duration of support was 121 h (ra nge 15-648 h). Four children (44%) were weaned from support and two of these are long-term survivors. Of the seven children in whom ECLS was instituted because of failure to wean from CPB, there was one long te rm survivor (LVAD support). Of the two patients in whom ECLS was insti tuted during the post-operative period there is one long-term survivor . Conclusions: Weaning form ECLS and decannulation in 44% of our patie nts is comparable to other series of post-cardiotomy patients requirin g ECLS. However, full veno-arterial ECMO instituted because of a failu re to wean from CPB during corrective surgery is associated with an ex tremely poor outcome (zero long-term survivors in six patients). (C) 1 998 Elsevier Science B.V. All rights reserved.