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The impact of extracorporeal membrane oxygenation on survival in pediatric patients with respiratory and heart failure: review of our experience.
MedLine Citation:
PMID:  22097977     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Extracorporeal membrane oxygenation (ECMO) is widely used for circulatory support in pediatric cardiac patients with low cardiac output and hypoxemia. We retrospectively evaluated the efficacy of ECMO support for respiratory and heart failure in infants and children. From April 2002 to February 2011, 14 patients aged 19 days to 20 years old (average 44 months), with body weight 2.6 kg to 71 kg (median 14.1 kg), underwent ECMO support for failing cardiac function, hypoxemia, and low cardiac output syndrome. In 12 patients, ECMO was introduced after operation for congenital heart disease (four with complete repair including Fontan circulation, and eight with palliative repair). In one patient, ECMO was introduced after partial pulmonary resection for congenital cystic adenomatoid malformation because of respiratory failure. ECMO was introduced in a patient with severe heart failure caused by fulminant myocarditis. Patients' demographics, duration of extracorporeal membrane oxygenation, additional support, and outcomes were analyzed. Ten patients (71%) were successfully weaned from ECMO, and eight patients (57%) were discharged from the hospital. The mean duration of ECMO support was 332 h (range 11-2030 h). Although management of the ECMO circuit, including anticoagulation (activated clotting time: 150-250), was conducted following the institutional practice guidelines, it was difficult to control the bleeding. Seven patients required renal replacement therapy during ECMO support using peritoneal dialysis or continuous hemodiafiltration. Five patients had additional operative procedures: systemic-pulmonary shunt in two, bidirectional Glenn takedown with right modified Blalock-Taussig shunt, total cavopulmonary connection takedown, and redo ECMO in one patient each. The patient who had the longest ECMO support for respiratory failure due to acute respiratory distress syndrome after lung surgery was successfully weaned from ECMO because high-frequency oscillation (HFO) improved respiratory function. ECMO for heart and respiratory failure in infants and children is effective and allows time for recovery of cardiac dysfunction and acute hypoxic insult. The long-term ECMO support for over 2000 h was very rare, but it was possible to wean this patient from ECMO using HFO.
Authors:
Takeshi Goto; Yasuyuki Suzuki; Yuta Suzuki; Ai Osanai; Kaori Aoki; Akio Yamazaki; Kazuyuki Daitoku; Ikuo Fukuda
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Artificial organs     Volume:  35     ISSN:  1525-1594     ISO Abbreviation:  Artif Organs     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802778     Medline TA:  Artif Organs     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1002-9     Citation Subset:  IM    
Copyright Information:
© 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
Affiliation:
Department of Clinical Engineering, Hirosaki University School of Medicine and Hospital Department of Thoracic Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.
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