Proposed entry criteria for postoperative cardiac extracorporeal membrane oxygenation after pediatric open heart surgery

While extracorporeal membrane oxygenation (ECMO) is being used increasingly after pediatric cardiac surgery, criteria are lacking for initiating ECMO after bypass weaning. To develop clinically useful ECMO entry criteria base d on parameters readily available, children were examined at postoperative pediatric intensive care unit (PICU) admission. Using hospital mortality as the primary outcome, univariate and multiple logistic regressions were per formed to estimate the predictive value of clinical (age, weight, and diagn osis) and laboratory (arterial blood pressure, pH, lactate, creatine kinase , and arterial and central venous oxygen saturation [ScvO(2)]) variables. D ata from 218 children over a 2 year period were analyzed retrospectively. U nivariate regression demonstrated that age, weight, diagnosis, blood pressu re, venous and arterial saturation, and lactate were significantly associat ed with postoperative mortality (p < 0.05). In multiple regression, ScvO(2) and lactate level were found to be independent predictors and were used in a predictive model (ScvO(2) odds ratio: 2.03-828.6, p = 0.016) (lactate od ds ratio: 1.58 -4.20, p = 0.0002) (R-2 = 0.70) Applying an 80% risk of mort ality to establish entry criteria as in neonatal ECMO, PICU admission value s of lactate > 70mg/dl if ScvO(2) < 60% or lactate > 163mg/dl if ScvO(2) > 60% are proposed to serve as postoperative ECMO entry criteria if bypass we aning has been possible but is followed by low cardiac output.