title: Postoperative extracorporeal life support in pediatric cardiac surgery: recent results.
abstract: We retrospectively reviewed the files of 19 extracorporeal life support (ECLS) applications performed after cardiac surgery in 15 patients from January 2002 to December 2004. We placed 16 arteriovenous ECLS applications with oxygenator, 2 venovenous ECLS applications with oxygenator, and 1 biventricular ECLS application without oxygenator (graft dysfunction after heart transplant). Mean age was 4.9 +/- 7 years (median 5.9 months, range 11 days to 21 years). All patients underwent surgery for congenital heart disease, except for one patient who had a heart transplant. Indications were hemodynamic failure in 12 cases, respiratory failure in 5 cases, and mixed failure in 2 cases. Four patients were undergoing cardiopulmonary resuscitation during ECLS placement (no deaths). Mean delay between surgery and ECLS placement was 3.2 +/- 3.4 days (median 2 days). Mean ECLS duration was 3.4 +/- 5.8 days (mean 6 days, range 3-16 days). Three patients had further surgery for residual lesions. Thirteen patients (86.7%) survived to ECLS weaning; 12 patients survived to hospital discharge (80%). No survivor presented obvious neurologic damage. Specific morbidity included reentry for bleeding, multiple transfusions, and mediastinitis. These results support early placement of ECLS in children whenever a severe postoperative hemodynamic or respiratory failure, refractory to medical treatment, is present.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Children's Hospital La Timone, Bd J. Moulin, 13005 Marseille, France. oghez@free.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Ghez
authors.forename: Horea
authors.initials: H
authors.lastname: Feier
authors.forename: Fabrice
authors.initials: F
authors.lastname: Ughetto
authors.forename: Alain
authors.initials: A
authors.lastname: Fraisse
authors.forename: Bernard
authors.initials: B
authors.lastname: Kreitmann
authors.forename: Dominique
authors.initials: D
authors.lastname: Metras
mesh_terms: D000293:Adolescent; D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications; D011184:Postoperative Period; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D013903:Thoracic Surgery; D013997:Time Factors; D016896:Treatment Outcome