[ECMO--extra corporeal membrane oxygenation as a bridge to recovery, following surgery for complex congenital cardiac anomalies, in children and neonates].
BACKGROUND
ECMO is used as a method for mechanical life support in the face of extreme cardiopulmonary failure. Most children and neonates that require ECMO do so because of respiratory failure unresponsive to conventional supportive measures. Less then 16% of the patients require ECMO support for the failing heart. The Sheba Medical Center, is one of two centers in Israel authorized by the Ministry of Health to use ECMO technique and is the only center that also performs pediatric cardiac surgery.


OBJECTIVE
To present our experience with ECMO support in patients with low cardiac output syndromes following open-heart surgery for congenital cardiac anomalies as compared to international experience.


METHODS
The charts of all pediatric and neonatal patients requiring ECMO support following cardiac surgery for complex congenital cardiac anomalies were reviewed. Patient and ECMO characteristics were compared, as well as the success rates.


RESULTS
Between 1995 and 2001, sixteen neonates and children were treated at our institution by ECMO for low cardiac output syndromes following heart surgery. Twelve were operated on at our institution, and four were referred to the ECMO unit of our pediatric critical care ward from other hospitals. ECMO support resulted in full recovery in seven of the sixteen patients, cardiac function returned to normal and the patients were discharged home in good condition, nine patients died.


CONCLUSIONS
Our experience is in accord with the reported international experience. Following cardiac surgery for congenital cardiac anomalies, low cardiac output, unresponsive to maximal conventional medical support, is a rare but life threatening condition. Extracorporeal membrane oxygenation serves as a rescue mechanical support for these patients and due to improved and sophisticated intensive care, can serve as a bridge to recovery. The availability of ECMO provides an extra margin of safety in the very complex cases of open-heart surgery.
D002303:Cardiac Output, Low / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011182:Postoperative Care