CARDIOVASCULAR COMPLICATIONS ADVERSELY AFFECT SURVIVAL DURING EXTRACORPOREAL MEMBRANE-OXYGENATION

Objectives: Extracorporeal membrane oxygenation (ECMO) has been used i n the management of infants with cardiorespiratory failure. ECMO cause s a decrease in load-dependent measures of cardiac performance that ha ve not been demonstrated to affect patient outcome, while other cardio vascular complications occur which may affect outcome. The purpose of this study was to describe the cardiovascular complications associated with ECMO, and to determine their relationship to survival. Design: D ata were obtained, retrospectively, from the medical records of 500 co nsecutive newborns treated with ECMO at our institution since 1984. Re sults: Hypertension(mean arterial pressure of >65 mm Hg) was the most common complication, requiring medical intervention in 192 infants. My ocardial stun, the near-total absence of systolic function during ECMO , occurred in 59 infants. Rhythm abnormalities, including noncannulati on-related bradycardia, occurred in 43 infants, cardiac arrest, and pe ricardial effusion in 17 infants, and noninfective thrombosis in 9 inf ants. Only one infant required ligation of a patent ductus arteriosus during ECMO. Infants with at least one cardiovascular complication had a lower survival rate, compared with those infants without a complica tion. Survival rates were decreased in infants with myocardial stun, a rrhythmia, and cardiac arrest. Hypertension and pericardial effusion w ere not associated with decreased survival. Conclusion: These findings suggest that some cardiovascular complications during ECMO are more c ommon than previously thought, and cardiovascular complications may ad versely impact outcome.