title: Setting Up an ECMO Program in a South American Country: Outcomes of the First 104 Pediatric Patients.
abstract: BACKGROUND
  Less than 1% of the extracorporeal life support organization (ELSO) registry patients are from South America. Extracorporeal membrane oxygenation (ECMO) is an expensive therapy not only in terms of direct financial cost but also with respect to technical and human resources. Finding a successful ECMO model that developing countries can afford is critical to the expansion of therapy to include the availability of this technology for patients in the developing world.
  
  
  METHODS
  We retrospectively studied the first 104 pediatric ECMO patients in the Fundacion Cardiovascular de Colombia between May 2007 and May 2013. We collected the ELSO registry data from electronic medical records to determine the survival rate, mortality risk factors, and complications in pediatric patients who received ECMO support for cardiac failure, respiratory failure, or ECMO for extracorporeal cardiopulmonary resuscitation in the setting of refractory cardiopulmonary resuscitation. We describe our model of ECMO care regarding staff, training process, care protocol, ECMO circuit, and costs.
  
  
  RESULTS
  Of 104 patients, 82 were diagnosed with congenital heart disease. Of those, 50 had biventricular and 32 had univentricular physiology, with a significantly higher survival rate at discharge in the biventricular group (44% vs 18.7%, odds ratio [OR] 3.6, 95% confidence interval [CI] = 1.28-10.52, P = .01). Pediatric patients with a cardiac indication had survival rates of 76.3% at weaning and 52.6% at discharge, which is roughly comparable to those reported by the ELSO in 2013. Univentricular physiology, ECPR, severe pre-ECMO acidosis, ECMO-associated renal failure, and duration of ECMO support were factors associated with increased mortality.
  
  
  CONCLUSIONS
  Despite limited availability of technical and economic resources, ECMO therapy can be done successfully in a developing country. A model of care based on nurses as ECMO specialists, supported by a multidisciplinary team, is cost-effective.
authors.affiliation: Department of Pediatric Cardiovascular Surgery and Research Center, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia carcaya13@gmail.com.
authors.forename: Claudia X
authors.initials: CX
authors.lastname: Flórez
authors.affiliation: Department of Pediatric Cardiovascular Surgery and Research Center, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia.
authors.forename: Anderson
authors.initials: A
authors.lastname: Bermon
authors.affiliation: Department of Pediatric Cardiovascular Surgery and Research Center, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia.
authors.forename: Victor R
authors.initials: VR
authors.lastname: Castillo
authors.affiliation: Department of Pediatric Cardiovascular Surgery and Research Center, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Salazar
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003105:Colombia; D004812:Epidemiologic Methods; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
keywords: cardiac surgical procedures; congenital; extracorporeal membrane oxygenation; heart defects