title: Clinical equivalency of cardiopulmonary bypass and extracorporeal membrane oxygenation support for pediatric tracheal reconstruction.
abstract: OBJECTIVE
  Pediatric surgery for congenital tracheal stenosis continues to be a therapeutic challenge, and it often requires cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) for intra-operative extracorporeal cardiorespiratory support. The purpose of this study was to compare the peri-operative outcomes of CPB with ECMO in pediatric tracheal reconstruction.
  
  
  METHODS
  Forty-three consecutive patients who underwent tracheal reconstruction without intra-cardiac repair for congenital tracheal stenosis at Kobe Children's Hospital between January 2000 and August 2012 were enrolled in this retrospective study. They were divided into two groups according to intra-operative extracorporeal cardiopulmonary support [CPB (n = 17) or ECMO (n = 26)]. Peri-operative variables were compared between the two groups.
  
  
  RESULTS
  The CPB and ECMO groups had similar patient and operative characteristics. However, the CPB group required larger priming volume and higher doses of total heparin injection. Although the ECMO group exhibited less peri-operative bleeding and lower red blood cell requirement, there were no statistically significant differences between the two groups. Compared to the ECMO group, patients in the CPB group had significantly less positive fluid balance during surgery and in the first 24 h after surgery, and exhibited a trend towards higher ratios of PO2to the fraction of inspired oxygen and lower PCO2at the time of ICU admission and on post-operative day 1.
  
  
  CONCLUSIONS
  Pediatric tracheal reconstruction should be performed with intra-operative CPB or ECMO, after considering the advantages of utilizing each extracorporeal cardiorespiratory support type according to the patient's specific condition and situation.
authors.affiliation: Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan. tohasegawa_kch@hp.pref.hyogo.jp.|Department of Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan. tohasegawa_kch@hp.pref.hyogo.jp.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Department of Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Matsuhisa
authors.affiliation: Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Okata
authors.affiliation: Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Yokoi
authors.affiliation: Department of Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Maeda
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000601:surgery*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D010372:Pediatrics / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013810:Therapeutic Equivalency; D014132:Trachea / Q000002:abnormalities* / Q000601:surgery; D016896:Treatment Outcome
keywords: Cardiopulmonary bypass; Extracorporeal membrane oxygenation support; Fluid management; Pediatric tracheal reconstruction