title: Post-cardiotomy ECMO in pediatric and congenital heart surgery: impact of team training and equipment in the results.
abstract: BACKGROUND
  Post-cardiotomy myocardial dysfunction requiring mechanical circulatory support occurs in about 0.5% of cases. In our environment, the use of extracorporeal membrane oxygenation has been increasing in recent years.
  
  
  OBJECTIVE
  To evaluate the impact of investment in professional training and improvement of equipment in the rate of weaning from extracorporeal membrane oxygenation and survival.
  
  
  METHODS
  A retrospective study. Fifty-six pediatric and/or congenital heart patients underwent post-cardiotomy extracorporeal membrane oxygenation at our institution between November 1999 and July 2014. We divided this period into two phases: phase I, 36 cases (before the structuring of the extracorporeal membrane oxygenation program) and phase II, 20 cases (after the extracorporeal membrane oxygenation program implementation) with investment in training and equipment). Were considered as primary outcomes: extracorporeal membrane oxygenation weaning and survival to hospital discharge. The results in both phases were compared using Chi-square test. To identify the impact of the different variables we used binary logistic regression analysis.
  
  
  RESULTS
  Groups were comparable. In phase I, 9 patients (25%) were weaned from extracorporeal membrane oxygenation, but only 2 (5.5%) were discharged. In phase II, extracorporeal membrane oxygenation was used in 20 patients, weaning was possible in 17 (85%), with 9 (45%) hospital discharges (P<0.01). When the impact of several variables on discharge and weaning of extracorporeal membrane oxygenation was analyzed, we observe that phase II was an independent predictor of better results (P<0.001) and need for left cavities drainage was associated with worse survival (P=0.045).
  
  
  CONCLUSIONS
  The investment in professional training and improvement of equipment significantly increased extracorporeal membrane oxygenation results.
authors.affiliation: Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Leonardo Augusto
authors.initials: LA
authors.lastname: Miana
authors.affiliation: Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Canêo
authors.affiliation: Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Carla
authors.initials: C
authors.lastname: Tanamati
authors.affiliation: Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Juliano Gomes
authors.initials: JG
authors.lastname: Penha
authors.affiliation: Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Vanessa Alves
authors.initials: VA
authors.lastname: Guimarães
authors.affiliation: Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Nana
authors.initials: N
authors.lastname: Miura
authors.affiliation: Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Filomena Regina Barbosa Gomes
authors.initials: FR
authors.lastname: Galas
authors.affiliation: Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Marcelo Biscegli
authors.initials: MB
authors.lastname: Jatene
mesh_terms: D004496:Education, Continuing / Q000706:statistics & numerical data*; D015199:Extracorporeal Membrane Oxygenation / Q000193:education* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge; D015397:Program Evaluation; D012189:Retrospective Studies; D015996:Survival Rate; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome