title: Survival of children requiring repeat extracorporeal membrane oxygenation after congenital heart surgery.
abstract: BACKGROUND
  Clinical indications and outcomes for children requiring multiple extracorporeal membrane oxygenation (ECMO) runs during a single hospital admission are rarely reported. We review indications, cannulation techniques, and outcomes for infants requiring multiple ECMO runs after congenital heart surgery.
  
  
  METHODS
  Demographic and ECMO-related data for all children requiring multiple ECMO runs during a single hospital admission from 1995 to 2008 were extracted from our institution's ECMO database. Survival was defined as survival to hospital discharge. Demographic and ECMO data were compared between survivors and nonsurvivors using the Mann-Whitney test for continuous and Fisher's exact test for categorical data.
  
  
  RESULTS
  Twenty children (5% of 391 ECMO runs) with a median age of 5 days (range, 4 to 180 days) and weight of 3.22 kg required repeat ECMO support for persistent cardiopulmonary dysfunction despite successful weaning from an index ECMO run. Of the two-ventricle repair group, tetralogy of Fallot, truncus arteriosus, and transposition constituted the majority of cardiac diagnoses (75%), whereas single-ventricle physiology made up the rest (25%). The median total ECMO duration was 191 hours (range, 77 to 485 hours), and median hospital length of stay was 41 days (range, 6 to 297 days). Five (25%) patients survived to discharge. When survivors were compared with nonsurvivors, there were no significant differences in demographics, single or biventricular repair, indication for ECMO support, or need for surgical reoperation while on ECMO. However, the incidence of renal failure was higher in nonsurvivors than in survivors after multiple ECMO runs (12 versus 2.0; p=0.03).
  
  
  CONCLUSIONS
  Survival in children undergoing congenital heart surgery requiring multiple ECMO runs is low, but 1 in 4 patients will survive to discharge. If a correctable lesion or ventricular impairment is present, repeat ECMO support may be justified. Development of renal failure is associated with nonsurvival in these patients.
authors.affiliation: Department of Cardiac Surgery, Children's Hospital Boston, Boston, Massachusetts, USA. jeffrey.shuhaiber@gmail.com
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Shuhaiber
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: Pedro
authors.initials: P
authors.lastname: del Nido
authors.forename: Frank
authors.initials: F
authors.lastname: Pigula
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male