title: Extracorporeal membrane oxygenation following Norwood stage 1 procedures at a single institution.
abstract: Extracorporeal membrane oxygenation (ECMO) is an important circulatory assist for children with refractory cardiopulmonary dysfunction, but its role and indications after a stage 1 Norwood procedure are controversial. We assessed outcomes and risk factors in patients who underwent a Norwood palliation and ECMO at our institution. We retrospectively reviewed all patients who underwent a Norwood procedure and were supported with ECMO between January 1998 and January 2010. Of the 91 children who underwent a Norwood procedure during the study period, there were 15 postoperative runs of ECMO in 12 patients. The diagnoses of the patients included five with hypoplastic left heart syndrome, five with a hypoplastic left heart syndrome variant, and two with critical aortic stenosis. A total of four patients underwent bilateral pulmonary artery banding, and two patients underwent aortic valvuloplasty before the stage 1 Norwood procedure. The mean age of the patients was 28±30 days, and mean body weight was 2.6±0.5kg at the induction of ECMO. The indications for ECMO were low cardiac output in six children, circulatory collapse needing cardiopulmonary resuscitation in six children, and hypoxemia in three children. Five of the 12 patients were successfully weaned from ECMO. The significant risk factors for the inability to be weaned from ECMO were a history of circulatory collapse requiring cardiopulmonary resuscitation, and the induction of ECMO in the intensive care unit. Induction of ECMO may be considered earlier when hemodynamics are unstable in impaired patients following a stage 1 Norwood procedure to avoid circulatory collapse.
authors.affiliation: Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan. uga-strah@hotmail.co.jp
authors.forename: Shinya
authors.initials: S
authors.lastname: Ugaki
authors.forename: Shingo
authors.initials: S
authors.lastname: Kasahara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kotani
authors.forename: Mahito
authors.initials: M
authors.lastname: Nakakura
authors.forename: Takuma
authors.initials: T
authors.lastname: Douguchi
authors.forename: Hideshi
authors.initials: H
authors.lastname: Itoh
authors.forename: Sadahiko
authors.initials: S
authors.lastname: Arai
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects; D010166:Palliative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012769:Shock / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome