Impact of multiple organ system dysfunction and nosocomial infections on survival of children treated with extracorporeal membrane oxygenation after heart surgery

Objectives: To evaluate whether cardiac and noncardiac variables may be use d to predict survival in children treated with extracorporeal membrane oxyg enation (ECMO) after cardiopulmonary bypass and to determine when to discon tinue ECMO support. Design: Retrospective review. Setting: Neonatal and pediatric intensive care units of Kosair children's H ospital. Patients: Fifty-nine children treated with ECMO after cardiopulmonary bypas s from 1987 through 1996, Interventions: None. Measurements and Main Results: Medical, nursing, operative, and perfusion r ecords for each patient were reviewed. The primary outcome measure was surv ival to hospital discharge. Cardiac and noncardiac variables were recorded at serial times. Nineteen of 59 patients (32%) survived, No cardiac variabl e was a clinically useful predictor of survival or marker for when to disco ntinue ECMO, Among the noncardiac variables, progressive multiple organ sys tem dysfunction and development of a nosocomial infection were significantl y associated with nonsurvival, No patient with a positive blood culture (n = 3) within the first 24 hrs of ECMO survived, and 21 of 24 children with a positive culture from any site during ECMO died (p = .007), Despite their higher mortality, children with positive cultures were supported with ECMO significantly longer than those with negative cultures (275 +/- 168 vs. 135 +/- 108 hrs, respectively; p = .0004), For all patients, the longest durat ion of ECMO that resulted in survival was 256 hrs, For children with a posi tive culture, the longest duration of support that resulted in survival was 200 hrs, Conclusions: Support with ECMO beyond 256 hrs was not associated with survi val, Progressive multiple organ system dysfunction and nosocomial infection s have a negative impact on survival. Serious consideration should he given to discontinuing ECMO support whenever there is a progressive increase in the number of abnormally functioning organ systems, a nosocomial infection occurs, or native cardiac function has not improved significantly by 250 hr s of ECMO support.