Experience with extracorporeal life support in pediatric patients after cardiac surgery.
Extracorporeal life support (ECLS) had been successfully used in neonatal respiratory failure, but cardiac ECLS has been used increasingly in recent years. The purpose of this study was to review our experience in pediatric patients supported by ECLS for postoperative circulatory failure and to analyze the factors associated with mortality. Between January 1999 and December 2004, 68 pediatric patients (< 18 years old) who received ECLS within 7 days after cardiac surgery at the National Taiwan University Hospital were included in this study. The overall survival rate of this cohort was 32.4%. Age and gender did not affect survival. Patients with separate biventricular physiology had a higher probability of survival than those with systemic-pulmonary shunt or cavopulmonary anastomosis (41.3% vs. 13.6%, p < 0.05). Acute renal failure during ECLS was significantly associated with mortality (83% vs. 33.5%, p < 0.001). After ECLS initiation, the lowest lactate levels on the second to fourth days were lower in survivors than in nonsurvivors (2.4 vs. 3.3 mmol/L, p < 0.05). There was a trend toward a better survival in the most recent 2 years in comparison with the previous 4 years (47.6% vs. 25.5%, p = 0.07), although this trend did not reach statistical significance. In conclusion, nonbiventricular physiology, acute renal failure, and high blood lactate levels after ECLS increased the risk of mortality for pediatric patients requiring ECLS for postoperative cardiac support.
Huang
Shu-Chien
SC
Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan S. Rd., Taipei 100, Taiwan.
Wu
En-Ting
ET
Chen
Yih-Sharng
YS
Chang
Chung-I
CI
Chiu
Ing-Sh
IS
Chi
Nai-Hsin
NH
Wu
Mei-Hwan
MH
Wang
Shoei-Shen
SS
Lin
Fang-Yue
FY
Ko
Wen-Je
WJ
D000208:Acute Disease; D000293:Adolescent; D002303:Cardiac Output, Low / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006336:Heart Massage / Q000401:mortality / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D051437:Renal Insufficiency / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan; D013903:Thoracic Surgery; D013997:Time Factors; D016896:Treatment Outcome