title: Outcomes of second-run extracorporeal life support in children: a single-institution experience.
abstract: BACKGROUND
  After weaning from mechanical circulatory support with extracorporeal membrane oxygenation or ventricular assist devices, patients may recurrently deteriorate and require reinstitution of support. Potential benefits of this desperate strategy are not well documented.
  
  
  METHODS
  We reviewed the hospital records of all patients in whom second-run mechanical circulatory support was instituted from May 1988 to August 2010.
  
  
  RESULTS
  Second-run support was instigated in 26 (4.6%) of 567 patients who underwent short-term mechanical circulatory support. Underlying pathologies requiring support were cardiac in 20 patients (76.9%) and noncardiac in 6 patients (23.1%).The majority of patients were younger than 1 year old (73.1%, n=19). Fifteen patients (57.7%) survived second-run support, but only 7 patients (26.9%) survived to discharge from the hospital. After a median follow-up of 42.5 months (range, 16 to 66 months), 4 patients (15.4%) were alive, but 3 of them had various degrees of developmental delay.
  
  
  CONCLUSIONS
  Selection of patients who can benefit from second-run support is a complex process with unpredictable results. Survival after second-run mechanical circulatory support in children is worse compared with single-run patients. Long-term prospects for survivors are so grim that this strategy should probably not be recommended.
authors.affiliation: Cardiac Surgery Unit, Royal Children's Hospital, Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Lyubomyr
authors.initials: L
authors.lastname: Bohuta
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
authors.forename: Derek
authors.initials: D
authors.lastname: Best
authors.forename: Peta
authors.initials: P
authors.lastname: Alexander
authors.forename: Luca
authors.initials: L
authors.lastname: Barozzi
authors.forename: Warwick
authors.initials: W
authors.lastname: Butt
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology