Extracorporeal membrane oxygenation for the treatment of children with severe hemodynamic alteration in perioperative cardiovascular surgery.
BACKGROUND
This article summarizes the use of extracorporeal membrane oxygenation (ECMO) for the treatment of children with severe hemodynamic alteration in perioperative cardiovascular surgery.


METHODS
Four children with congenital heart disease (CHD) (3 boys and 1 girl, aged 6 days to 4 years and weighing 2.8-15 kg) associated with severe heart failure and/or hypoxemia were treated with ECMO cardiopulmonary support in perioperative cardiovascular surgery between July 2007 and July 2008. We retrospectively analyzed the medical records of the 4 children.


RESULTS
Of the 4 children, 2 survived and 2 died. The survivors were treated with venoarterial (VA) ECMO due to severe low output syndrome after arterial switch operation. They were weaned successfully from 22-hour and 87-hour ECMO support, and discharged 20 days and 58 days after ECMO explantation, respectively. The other boy treated with venovenous ECMO died of severe hypoxemia and metabolic acidosis. The other girl with VSD, treated with VA ECMO because of failure to wean from cardiopulmonary bypass, died from irreversible heart failure 11 hours after ECMO explantation. The main complications in this series included pulmonary hemorrhage, blood tamponade, surgical site bleeding, hemolysis and hyperbilirubinemia.


CONCLUSIONS
ECMO is an effective therapy for patients with severe heart failure in the perioperative cardiovascular surgery. The keys to successful ECMO are selection of indications, time to set up ECMO, and good management of complications during ECMO.
Ye
Li-Fen
LF
Department of Cardiothoracic Surgery, Children's Hospital, Zhejiang University School of Medicine and Zhejiang Key Laboratory for Diagnosis and Therapy of Neonatal Diseases, Hangzhou, 310003, China.
Fan
Yong
Y
Tan
Lin-Hua
LH
Shi
Li-Ping
LP
Zhang
Ze-Wei
ZW
Du
Li-Zhong
LZ
Shu
Qiang
Q
Lin
Ru
R
D013504:Cardiovascular Surgical Procedures; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019990:Perioperative Care; D012189:Retrospective Studies