Intraoperative extracorporeal membrane oxygenation and survival of pediatric patients undergoing repair of congenital heart disease.
BACKGROUND
We studied the association between the introduction of extracorporeal membrane oxygenation (ECMO) into routine practice and the survival of children who failed weaning from cardiopulmonary bypass (CPB). We compare two periods, before formal introduction of ECMO in our institution (1993-1999, pre-ECMO era) and after ECMO became a formalized program (2000-2006, ECMO era).


METHODS
Retrospective review of Mayo Clinic Database between 1993 and 2006 for outcomes of patients <18 years old who required ECMO during repair of congenital heart malformations.


RESULTS
Thirty-five children during ECMO era received intraoperative ECMO, and 17 (54%) survived to hospital discharge. The frequency of ECMO use was the highest in neonates, therefore, this was the only subcohort of pediatric patients that allowed comparison of survival between the pre-ECMO and ECMO eras. When compared to pre-ECMO era, neonatal survival increased during ECMO era (P = 0.043). ECMO was mostly used in neonates with higher complexity of cardiac defects undergoing more complex repairs, and the overall improvement of survival was primarily due to better survival of these patients. During pre-ECMO era, survival was lower in patients with higher risk (P = 0.001). However, during ECMO era, no difference in survival was observed across assigned risk groups (P = 0.658).


CONCLUSIONS
The availability of ECMO for neonates failing to wean from CPB was associated with improved survival, especially in children undergoing repair of the most complex congenital heart malformations. After introduction of ECMO, survival improved and no longer depended upon the complexity of surgical repair.
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Randall P
RP
Flick
Juraj
J
Sprung
Stephen J
SJ
Gleich
Roxann D
RD
Barnes
David O
DO
Warner
Joseph A
JA
Dearani
Phillip D
PD
Scott
Andrew C
AC
Hanson
Darrell R
DR
Schroeder
Gregory J
GJ
Schears
D000293:Adolescent; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality* / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016343:Monitoring, Intraoperative; D017410:Practice Guidelines as Topic; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome