Extracorporeal membrane oxygenation discontinuation despite technically successful reoperation: A case report.
Death remains a probable outcome of pediatric cardiac extracorporeal membrane oxygenation (ECMO) despite increasing efforts to improve the results. On venoarterial ECMO, in an obviously hopeless situation, the decision to withdraw a life supporting measure resulting in the sudden death of a child places a heavy burden on the team. After valvulotomy of critical aortic stenosis in a prenatally diagnosed term neonate, ECMO had to be installed during postoperative resuscitation. Despite technically successful homograft implantation while on ECMO complicated by postoperative bleeding, advancing multiorgan failure resulted in ECMO withdrawal. As shown in this case report, exact termination criteria are lacking but are necessary to prevent increasing team and resource related conflicts in pediatric cardiac ECMO.
Taferner
R
R
Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Vienna, Austria.
Golej
J
J
Marx
M
M
Trittenwein
G
G
D001021:Aortic Valve / Q000637:transplantation; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002305:Cardiac Tamponade / Q000209:etiology; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004374:Ductus Arteriosus, Patent / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation; D017809:Fatal Outcome; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D012086:Reoperation; D014184:Transplantation, Homologous; D016896:Treatment Outcome