title: Delayed extracorporeal membrane oxygenation in children after cardiac surgery: two-institution experience.
abstract: OBJECTIVE
  There are limited data on the outcomes of children receiving delayed (≥7 days) extracorporeal membrane oxygenation after cardiac surgery. The primary aim of this project is to identify the aetiology and outcomes of extracorporeal membrane oxygenation in children receiving delayed (≥7 days) extracorporeal membrane oxygenation after cardiac surgery.
  
  
  METHODS
  We conducted a retrospective review of all children ≤18 years supported with delayed extracorporeal membrane oxygenation after cardiac surgery between the period January, 2001 and March, 2012 at the Arkansas Children's Hospital, United States of America, and Royal Children's Hospital, Australia. The data collected in our study included patient demographic information, diagnoses, extracorporeal membrane oxygenation indication, extracorporeal membrane oxygenation support details, medical and surgical history, laboratory, microbiological, and radiographic data, information on organ dysfunction, complications, and patient outcomes. The outcome variables evaluated in this report included: survival to hospital discharge and current survival with emphasis on neurological, renal, pulmonary, and other end-organ function.
  
  
  RESULTS
  During the study period, 423 patients undergoing cardiac surgery were supported with extracorporeal membrane oxygenation at two institutions, with a survival of 232 patients (55%). Of these, 371 patients received extracorporeal membrane oxygenation <7 days after cardiac surgery, with a survival of 205 (55%) patients, and 52 patients received extracorporeal membrane oxygenation ≥7 days after cardiac surgery, with a survival of 27 (52%) patients. The median duration of extracorporeal membrane oxygenation run for the study cohort was 5 days (interquartile range: 3, 10). In all, 14 patients (25%) received extracorporeal membrane oxygenation during active cardiopulmonary resuscitation with chest compressions. There were 24 patients (44%) who received dialysis while being on extracorporeal membrane oxygenation. There were eight patients (15%) who had positive blood cultures and four patients (7%) who had positive urine cultures while being on extracorporeal membrane oxygenation. There were nine patients (16%) who had bleeding complications associated with extracorporeal membrane oxygenation runs. There were 10 patients (18%) who had cerebrovascular thromboembolic events associated with extracorporeal membrane oxygenation runs. Of these, 19 patients are still alive with significant comorbidities.
  
  
  CONCLUSIONS
  This study demonstrates that mortality outcomes are comparable among children receiving extracorporeal membrane oxygenation ≥7 days and <7 days after cardiac surgery. The proportion of patients receiving extracorporeal membrane oxygenation ≥7 days is small and the aetiology diverse.
authors.affiliation: 1Department of Pediatrics,Division of Pediatric Cardiology,University of Arkansas for Medical Sciences,Little Rock,United States of America.
authors.forename: Punkaj
authors.initials: P
authors.lastname: Gupta
authors.affiliation: 2Department of Anesthesia,Division of Pediatric Anesthesiology,University of Arkansas for Medical Sciences,Little Rock,United States of America.
authors.forename: Rahul
authors.initials: R
authors.lastname: DasGupta
authors.affiliation: 3Department of Pediatric Intensive Care,The Royal Children's Hospital,Melbourne,Australia.
authors.forename: Derek
authors.initials: D
authors.lastname: Best
authors.affiliation: 4Department of Pediatrics,Pediatric Residency Program,University of Arkansas for Medical Sciences,United States of America.
authors.forename: Craig B
authors.initials: CB
authors.lastname: Chu
authors.affiliation: 5Department of Mathematics and Statistics,University of Arkansas,United States of America.
authors.forename: Hassan
authors.initials: H
authors.lastname: Elsalloukh
authors.affiliation: 6Department of Pediatrics,Division of Biostatistics,University of Arkansas for Medical Sciences,Little Rock,United States of America.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Gossett
authors.affiliation: 7Department of Pediatric Cardiothroacic Surgery,University of Arkansas for Medical Sciences,Little Rock,United States of America.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.affiliation: 3Department of Pediatric Intensive Care,The Royal Children's Hospital,Melbourne,Australia.
authors.forename: Warwick
authors.initials: W
authors.lastname: Butt
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000628:therapy; D002303:Cardiac Output, Low / Q000453:epidemiology / Q000628:therapy*; D006348:Cardiac Surgical Procedures; D016887:Cardiopulmonary Resuscitation; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012769:Shock / Q000453:epidemiology / Q000628:therapy
keywords: mortality