Document Detail


Extracorporeal life support for cardiac assist in pediatric patients. Review of ELSO Registry data.
MedLine Citation:
PMID:  1934407     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The collected data on extracorporeal membrane oxygenation (ECMO), now referred to as extracorporeal life support (ECLS), for pediatric cardiac support has not been analyzed. The purpose of this study was to review the Extracorporeal Life Support (ELSO) Registry data to evaluate the results, identify possible predictors of outcome, and attempt to establish criteria. From 1981 to June of 1990, 189 patients were placed on ECLS for cardiac assist. The age range was 0-204 months (median, 7 months). Mean time on ECLS was 115 +/- 75 hours. Fourteen patients were placed on ECLS as a bridge to transplant or for management of transplant rejection. All of the remaining 175 patients were treated in the postoperative period. The causes of mortality included lack of improvement in cardiovascular function in 69 (37%) of the patients, major central nervous system damage in 28 (15%), uncontrollable hemorrhage in three (2%), sepsis in three (2%), and pulmonary interstitial disease in two (1%). The Registry data were examined for predictors of outcome. There was no significant difference between survivors and nonsurvivors when compared for duration of ECLS, mechanical complications, arterial or venous blood gases, ventilation settings, or hemodynamics. Forty-three percent of 189 pediatric patients treated with ECLS for cardiac failure survived. The highest survival, 61%, occurred in right-sided lesions and the lowest, 18%, in post-Fontan. Mediastinal bleeding, cardiac arrest, renal failure, and prolonged intubation were all associated with a poor outcome. Most deaths were attributed to irreversible cardiac or brain injury, suggesting that results could be improved by earlier identification of high-risk patients and earlier institution of ECLS.
Authors:
J N Meliones; J R Custer; S Snedecor; F W Moler; P P O'Rourke; R E Delius
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  84     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1991 Nov 
Date Detail:
Created Date:  1991-12-16     Completed Date:  1991-12-16     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  III168-72     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatric Critical Care, University of Michigan Medical Center, Ann Arbor 48109.
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MeSH Terms
Descriptor/Qualifier:
Assisted Circulation
Extracorporeal Membrane Oxygenation / mortality*
Female
Heart Defects, Congenital / mortality,  therapy*
Heart Transplantation
Humans
Infant
Male
Registries
Retrospective Studies
Risk Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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