Severe myocardial dysfunction during extracorporeal membrane oxygenation.
Of the 102 neonates with respiratory failure supported with extracorporeal membrane oxygenation (ECMO) at this institution between 1984 and 1987, 8 patients developed severe myocardial dysfunction that was noted shortly after onset of bypass. The neonates in the cardiac dysfunction group were more hypoxic (average PaO2 = 26 +/- 8 mm Hg v 41 +/- 19 mm Hg, P less than .01) in the immediate pre-ECMO period. Seventy-five percent were unstable hemodynamically (6 hypotensive, 3 bradycardic, 2 sustained cardiac arrest, 4 required epinephrine pressor support). On ECMO, 5 of the 8 neonates developed an ischemic cardiomyopathy that lasted for less than 24 hours and resolved without therapeutic intervention. In the other 3 cases, prolonged periods of dysfunction were noted and afterload reduction through administration of tolazoline or hydralazine was beneficial. These 8 patients serve to demonstrate the reversible nature of postischemic cardiac dysfunction in patients on ECMO and in the neonatal population in general.
Hirschl
R B
RB
Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0331.
Heiss
K F
KF
Bartlett
R H
RH
D004562:Electrocardiography; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006321:Heart / Q000503:physiopathology*; D006331:Heart Diseases / Q000209:etiology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000150:complications; D007231:Infant, Newborn; D015428:Myocardial Reperfusion Injury / Q000209:etiology* / Q000503:physiopathology; D010100:Oxygen / Q000097:blood; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies
D010100:Oxygen