Document Detail

Extracorporeal membrane oxygenation support of the Fontan and bidirectional Glenn circulations.
MedLine Citation:
PMID:  15063263     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Extracorporeal membrane oxygenation can provide effective mechanical circulatory support for the failing circulation in children. Patients with failing Fontan and bidirectional Glenn physiology present additional challenges both for extracorporeal membrane oxygenation cannulation and support. We report our institutional experience in patients with cavopulmonary connections who received extracorporeal membrane oxygenation. METHODS: We performed a retrospective review of 20 patients with cavopulmonary connections (14 Fontan and 6 bidirectional Glenn) who were supported with extracorporeal membrane oxygenation from a single, large pediatric tertiary care center. RESULTS: Of the 20 patients, ten were supported and decannulated successfully (50%) (two after cardiac transplantation), but only six (30%) are alive at follow-up. Of the 14 Fontan patients, seven (50%) were withdrawn from extracorporeal membrane oxygenation or died within 48 hours of decannulation due to lack of myocardial recovery or severe neurologic injury. All four adult-sized (> 40 kg) Fontan patients were withdrawn from extracorporeal support. The seven Fontan patients who were successfully decannulated survived to discharge, and five (35.7%) are alive at follow-up (median 35 months; range, 7 to 140 months). Of the six bidirectional Glenn patients, five died before hospital discharge and the lone survivor has neurologic injury at follow-up. CONCLUSIONS: Patients with failing Fontan and bidirectional Glenn physiology present significant challenges to successful extracorporeal membrane oxygenation support. While the morbidity and mortality rates are high, there are select patients for whom extracorporeal support can be effective and lifesaving as a short-term resuscitative intervention.
Karen L Booth; Stephen J Roth; Ravi R Thiagarajan; Melvin C Almodovar; Pedro J del Nido; Peter C Laussen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  77     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-04-05     Completed Date:  2004-05-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1341-8     Citation Subset:  AIM; IM    
Department of Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
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MeSH Terms
Anastomosis, Surgical
Child, Preschool
Extracorporeal Membrane Oxygenation* / adverse effects
Fontan Procedure*
Palliative Care
Postoperative Complications / therapy
Pulmonary Artery / surgery*
Respiratory Insufficiency / etiology,  therapy
Retrospective Studies
Treatment Outcome
Vena Cava, Superior / surgery*

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