Extracorporeal membrane oxygenation in children after repair of congenitalcardiac lesions

Background. The purpose of this study was to review our experience in the e arly application of extracorporeal membrane oxygenation (ECMO) in patients requiring mechanical assistance after cardiac surgical procedures. Methods. The hospital records of all children requiring ECMO after cardiac operation were retrospectively reviewed, and an analysis of variables affec ting survival was performed. Results. Fifty pediatric patients between May 1997 and October 2000 require d ECMO for cardiopulmonary support after cardiac operation. Patients ranged in age from 1 day to 11 years (median age, 40 days). Forty-eight patients underwent repair of congenital cardiac lesions and 2 were included after re ceiving a heart transplant. Twenty-two children could not be weaned from ca rdiopulmonary bypass and were placed on ECMO in the operating room for circ ulatory support. Of the 28 children who required ECMO in the intensive care unit, 10 had ECMO instituted after cardiopulmonary arrest (mean cardiopulm onary resuscitation time, 42 minutes; range, 5 to 110 minutes). In infants with single-ventricle physiology, survival to discharge was 61% (11 of 18 p atients) as compared with 43% (14 of 32 patients) in those with biventricul ar physiology. Thirty of the 50 patients (60%) were successfully weaned fro m ECMO, of which 25 (83%) were discharged home. Overall survival to dischar ge in the entire cohort was 50%. Extracorporeal membrane oxygenation suppor t greater than 72 hours was a grave prognostic indicator. Overall survival in this group was 36% (9 of 25 patients) compared with 56% (14 of 25 patien ts) in those with ECMO support less than 72 hours (p < 0.05). Univariate an alysis revealed the presence of renal failure, extended periods of circulat ory support, and a prolonged period of cardiopulmonary resuscitation as ris k factors for mortality. The presence of shunt-dependent flow, operative pr ocedure, and institution of ECMO in the intensive care unit did not alter s urvival. Conclusions. Extracorporeal membrane oxygenation provides effective support for postoperative cardiac and pulmonary failure refractory to medical mana gement. Early institution of ECMO may decrease the incidence of cardiac arr est and end-organ damage, thus increasing survival in these critically ill patients. (C) 2001 by The Society of Thoracic Surgeons.