title: Proposed entry criteria for postoperative cardiac extracorporeal membrane oxygenation after pediatric open heart surgery.
abstract: While extracorporeal membrane oxygenation (ECMO) is being used increasingly after pediatric cardiac surgery, criteria are lacking for initiating ECMO after bypass weaning. To develop clinically useful ECMO entry criteria based on parameters readily available, children were examined at postoperative pediatric intensive care unit (PICU) admission. Using hospital mortality as the primary outcome, univariate and multiple logistic regressions were performed to estimate the predictive value of clinical (age, weight, and diagnosis) and laboratory (arterial blood pressure, pH, lactate, creatine kinase, and arterial and central venous oxygen saturation [ScvO2]) variables. Data from 218 children over a 2 year period were analyzed retrospectively. Univariate regression demonstrated that age, weight, diagnosis, blood pressure, venous and arterial saturation, and lactate were significantly associated with postoperative mortality (p < 0.05). In multiple regression, ScvO2 and lactate level were found to be independent predictors and were used in a predictive model (ScvO2 odds ratio: 2.03-828.6, p = 0.016) (lactate odds ratio: 1.58 -4.20, p = 0.0002) (R2 = 0.70). Applying an 80% risk of mortality to establish entry criteria as in neonatal ECMO, PICU admission values of lactate > 70 mg/dl if ScvO2 < 60% or lactate >163 mg/dl if ScvO2 > 60% are proposed to serve as postoperative ECMO entry criteria if bypass weaning has been possible but is followed by low cardiac output.
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Trittenwein
authors.forename: H
authors.initials: H
authors.lastname: Pansi
authors.forename: B
authors.initials: B
authors.lastname: Graf
authors.forename: J
authors.initials: J
authors.lastname: Golej
authors.forename: G
authors.initials: G
authors.lastname: Burda
authors.forename: M
authors.initials: M
authors.lastname: Hermon
authors.forename: M
authors.initials: M
authors.lastname: Marx
authors.forename: G
authors.initials: G
authors.lastname: Wollenek
authors.forename: H
authors.initials: H
authors.lastname: Trittenwein
authors.forename: A
authors.initials: A
authors.lastname: Pollak
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D001794:Blood Pressure; D001835:Body Weight; D002303:Cardiac Output, Low / Q000209:etiology / Q000628:therapy; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation; D005544:Forecasting; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007773:Lactates / Q000097:blood; D016015:Logistic Models; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010100:Oxygen / Q000097:blood; D010343:Patient Admission; D018579:Patient Selection; D011182:Postoperative Care; D012189:Retrospective Studies
chemical_list: D007773:Lactates; D010100:Oxygen