title: Clinical outcomes of 84 children with congenital heart disease managed with extracorporeal membrane oxygenation after cardiac surgery.
abstract: The purpose of our research was to study the clinical outcomes of children with congenital heart disease (CHD) requiring extracorporeal membrane oxygenation (ECMO) support after cardiac surgery at a tertiary care children's hospital. Retrospective review of all patients with CHD who required postcardiotomy ECMO between January 2001 and September 2004 (45 months) was undertaken. Various outcome predictors were tested for any association with survival to hospital discharge using univariate analysis. A total of 84 children were placed on ECMO after CHD surgery; 39 (46.4%) were placed on ECMO in the operating room. Median age of the patients was 128 days (1 day to 5 years) and median weight was 4.53 kg (2-18 kg). Active cardiopulmonary resuscitation was ongoing at the time of cannulation in 27 children (32%). Fifty-two children (61.9) survived > 24 hours after decannulation and 31 (36.9%) survived to discharge. High arterial serum lactate levels at the time of ECMO initiation were strongly correlated with nonsurvival (p = 0.004). Nonsurvivors had longer duration on ECMO than survivors (p = 0.003). The odds of survival dropped significantly after 144 hours (day 6) of ECMO. ECMO support results in improved outcomes in patients who suffered hemodynamic collapse post cardiac surgery. Underlying cardiac lesion, age, weight, gender, initial arterial pH, location of ECMO initiation, need for hemofiltration and placement of ECMO after active ongoing cardiopulmonary resuscitation did not increase the mortality risk. Initial arterial serum lactate level and inability to wean off by 6 days were strongly correlated with nonsurvival.
authors.affiliation: Department of Cardiac Surgery, Monroe Carrel Jr Children's Hospital, Nashville, TN, USA.
authors.forename: Salman A
authors.initials: SA
authors.lastname: Shah
authors.forename: V
authors.initials: V
authors.lastname: Shankar
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Churchwell
authors.forename: Mary B
authors.initials: MB
authors.lastname: Taylor
authors.forename: B P
authors.initials: BP
authors.lastname: Scott
authors.forename: Randall
authors.initials: R
authors.lastname: Bartilson
authors.forename: Dan W
authors.initials: DW
authors.lastname: Byrne
authors.forename: Karla G
authors.initials: KG
authors.lastname: Christian
authors.forename: Davis C
authors.initials: DC
authors.lastname: Drinkwater
mesh_terms: D016887:Cardiopulmonary Resuscitation; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006330:Heart Defects, Congenital / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D013903:Thoracic Surgery; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States