Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome.
OBJECTIVE
Although extracorporeal membrane oxygenation (ECMO) is an acceptable strategy for children with refractory cardiac dysfunction after cardiac surgery, its role after stage I reconstruction for hypoplastic left heart syndrome and its variants is controversial. Our objective is to describe the outcome of "nonelective" ECMO after stage I reconstruction.


METHODS
Retrospective case series.


METHODS
Pediatric cardiac intensive care unit.


METHODS
Infants placed on ECMO after stage I reconstruction from January 1998 to May 2005.


METHODS
None.


RESULTS
Of the 382 infants who underwent stage I reconstruction during the study period, 36 (9.4%) required ECMO in the postoperative period. There were 22 infants with hypoplastic left heart syndrome. Indications for ECMO included inability to separate from cardiopulmonary bypass in 14 and cardiac arrest in 22. Fourteen infants (38.8%) survived to hospital discharge. Nonsurvivors had longer cardiopulmonary bypass time (150.1 +/- 70.0 mins vs. 103.9 +/- 30.0 mins, p =. 01). 9/14 infants (64%) supported with ECMO> than 24 hrs after stage I reconstruction survived while only 5/22 infants (22%) requiring ECMO< 24 hrs of stage I reconstruction survived (p =. 02). Of note, all five infants diagnosed with an acute shunt thrombosis were early survivors. Mean duration of ECMO was 50.1 +/- 12.5 hrs for survivors and 125.2 +/- 25.0 for nonsurvivors (p =. 01). 7/14 early survivors are alive at a median follow-up of 20 months (2-78 months).


CONCLUSIONS
In our experience, ECMO after stage I reconstruction can be life saving in about a third of infants with otherwise fatal conditions. It is particularly useful in potentially reversible conditions such as acute shunt thrombosis and transient depression of ventricular function.
Ravishankar
Chitra
C
Division of Cardiology, The Children's Hospital of Philadelphia, PA 19104-4399, USA. Ravishankar@email.chop.edu
Dominguez
Troy E
TE
Kreutzer
Jacqueline
J
Wernovsky
Gil
G
Marino
Bradley S
BS
Godinez
Rodolfo
R
Priestley
Margaret A
MA
Gruber
Peter J
PJ
Gaynor
William J
WJ
Nicolson
Susan C
SC
Spray
Thomas L
TL
Tabbutt
Sarah
S
D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011182:Postoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome