Rapid cardiopulmonary support in children with heart disease: a nine-year experience.
BACKGROUND
We developed a novel mechanical rapid cardiopulmonary support system (CPS) in 1996 to eliminate what we believed were shortcomings of conventional extracorporeal membrane oxygenation (ECMO) circuits when used in patients with congenital heart disease. We reviewed the use of this system over a nine year period to determine if we had been successful in improving results compared with ECMO and if outcomes have changed over this time.


METHODS
All children supported with CPS (110 procedures) were reviewed. Noncardiac CPS cases (7) were excluded. The study population was divided into two time periods (1995 to 2000 and 2001 to 2004), which correlate with significant differences in intraoperative, postoperative, and CPS management. Patients were further analyzed by age (< or = 30 days or > 30 days), repair complexity (risk adjusted classification for congenital heart surgery [RACHS]-1 category 6 or categories 1 to 5), and length of support.


RESULTS
Overall thirty day survival of cardiac CPS patients was 55% (57 of 103). Overall survival increased from 45% (23 of 51) during the first period to 65% (34 of 52) during the second period [p < or = 0.005]. Survival rates in neonates improved from 41% (11 of 27) to 56% (15 of 27) and RACHS-1 category 6 survival improved from 38% (5 of 13) to 69% (9 of 13), but neither change reached statistical significance. Intracranial hemorrhage occurred in 6.4% of all CPS patients.


CONCLUSIONS
Cardiopulmonary support is an effective alternative to ECMO for pediatric cardiac support. Further, our experience suggests that patient survival may be improved by CPS compared with reported results for ECMO in cardiac patients.
Hannan
Robert L
RL
Congenital Heart Institute at Miami Children's Hospital, Miami, Florida 33155-4069, USA. rhannan001@aol.com
Ojito
Jorge W
JW
Ybarra
Marion A
MA
O'Brien
Michael C
MC
Rossi
Anthony F
AF
Burke
Redmond P
RP
D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005112:Extracorporeal Circulation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome