Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-23T17:15:16.235Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery

Published online by Cambridge University Press:  20 November 2019

Ahmed M. Dohain Open the ORCID record for Ahmed M. Dohain [Opens in a new window] ,
Gaser Abdelmohsen ,
Ahmed A. Elassal ,
Ahmed F. ElMahrouk  and
Osman O. Al-Radi
Ahmed M. Dohain*
Affiliation:
Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Giza, Egypt
Gaser Abdelmohsen
Affiliation:
Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Giza, Egypt
Ahmed A. Elassal
Affiliation:
Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia Department of Cardiothoracic Surgery, Zagazig University, Zagazig, Egypt
Ahmed F. ElMahrouk
Affiliation:
Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
Osman O. Al-Radi
Affiliation:
Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
*
Author for correspondence: A. M. Dohain, Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia; Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Giza, Egypt. Tel: +966 541 611 496; Fax: +966 126 952 538; E-mails: [email protected]; [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Extracorporeal membrane oxygenation has been widely used after paediatric cardiac surgery due to increasing complex surgical repairs in neonates and infants having complex CHDs.

Materials and methods:

We reviewed retrospectively the medical records of all patients with CHD requiring corrective or palliative cardiac surgery at King Abdulaziz University Hospital that needed extracorporeal membrane oxygenation support between November 2015 and November 2018.

Results:

The extracorporeal membrane oxygenation population was 30 patients, which represented 4% of 746 children who had cardiac surgery during this period. The patients’ age range was from 1 day to 20.33 years, with a median age of 6.5 months. Median weight was 5 kg (range from 2 to 53 kg). Twenty patients were successfully decannulated (66.67%), and 12 patients (40%) were survived to hospital discharge. Patients with biventricular repair tended to have better survival rate compared with those with single ventricle palliation (55.55 versus 16.66%, p-value 0.058). During the first 24 hours of extracorporeal membrane oxygenation support, the flow rate was significantly reduced after 4 hours of extracorporeal membrane oxygenation connection in successfully decannulated patients.

Conclusion:

Survival to hospital discharge in patients requiring extracorporeal membrane oxygenation support after paediatric cardiac surgery was better in those who underwent biventricular repair than in those who had univentricular palliation. Capillary leak on extracorporeal membrane oxygenation could be a risk of mortality in patients after paediatric cardiac surgery.

Keywords

Extracorporeal membrane oxygenationCHDcardiac surgerypaediatricsurvival
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1501 - 1509
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alsoufi, B, Awan, A, Manlhiot, C, et al. Does single ventricle physiology affect survival of children requiring extracorporeal membrane oxygenation support following cardiac surgery? World J Pediatr Congenit Heart Surg 2014; 5: 7–15. doi: 10.1177/2150135113507292 CrossRefGoogle ScholarPubMed
Van Arsdell, GS, Gruenwald, C, McCrindle, BW, et al. Extra-corporeal life support following cardiac surgery in children: analysis of risk factors and survival in a single institution. Eur J Cardio-Thoracic Surg 2009; 35: 1004–1011. doi: 10.1016/j.ejcts.2009.02.015 Google Scholar
Bautista-Hernandez, V, Thiagarajan, RR, Fynn-Thompson, F, et al. Preoperative extracorporeal membrane oxygenation as a bridge to cardiac surgery in children with congenital heart disease. Ann Thorac Surg 2009; 88: 1306–1311. doi: 10.1016/j.athoracsur.2009.06.074 CrossRefGoogle ScholarPubMed
Baslaim, G, Bashore, J, Al-Malki, F, Jamjoom, A. Can the outcome of pediatric extracorporeal membrane oxygenation after cardiac surgery be predicted? Ann Thorac Cardiovasc Surg 2006; 12: 21–27.Google ScholarPubMed
Raithel, SC, Pennington, DG, Boegner, E, Fiore, A, Weber, TR. Extracorporeal membrane oxygenation in children after cardiac surgery. Circulation 1992; 86: II305–II310.Google ScholarPubMed
Ghez, O, Feier, H, Ughetto, F, Fraisse, A, Kreitmann, B, Metras, D. Postoperative extracorporeal life support in pediatric cardiac surgery: recent results. ASAIO J 2005; 51: 513–516.CrossRefGoogle ScholarPubMed
Sasson, L, Cohen, I, Tamir, A, et al. Extracorporeal membrane oxygenation in pediatric patients: our experience in the last ten years. Isr Med Assoc J 2013; 15: 13–16.Google ScholarPubMed
Chaturvedi, RR, Macrae, D, Brown, KL, et al. APG. Cardiac ECMO for biventricular hearts after paediatric open heart surgery. Heart 2004; 90: 545–551. doi: 10.1136/hrt.2002.003509 CrossRefGoogle Scholar
Paden, ML, Conrad, SA, Rycus, PT, Thiagarajan, RR. Extracorporeal Life Support Organization Registry Report 2012. ASAIO J 2013; 59: 202–210. doi: 10.1097/MAT.0b013e3182904a52 CrossRefGoogle ScholarPubMed
Kolovos, NS, Bratton, SL, Moler, FW, et al. Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery. Ann Thorac Surg 2003; 76: 1435–1441. doi: 10.1016/S0003-4975(03)00898-1 CrossRefGoogle ScholarPubMed
Loforte, A, Delmo Walter, EM, Stiller, B et al. Extracorporeal membrane oxygenation for intraoperative cardiac support in children with congenital heart disease. Interact Cardiovasc Thorac Surg 2010; 10: 753–758. doi: 10.1510/icvts.2009.220475 CrossRefGoogle Scholar
Aharon, AS, Drinkwater, DC, Churchwell, KB, et al. Extracorporeal membrane oxygenation in children after repair of congenital cardiac lesions. Ann Thorac Surg 2001;72: 2095–2102. doi: 10.1016/S0003-4975(01)03209-X CrossRefGoogle ScholarPubMed
Duncan, BW, Hraska, V, Jonas, RA, et al. Mechanical circulatory support in children with cardiac disease. J Thorac Cardiovasc Surg 1999; 117: 529–542.CrossRefGoogle ScholarPubMed
ElMahrouk, AF, Ismail, MF, Hamouda, T, et al. Extracorporeal membrane oxygenation in postcardiotomy pediatric patients-15 years of experience outside Europe and North America. Thorac Cardiovasc Surg 2019; 67: 28–36. doi: 10.1055/s-0037-1608962 Google ScholarPubMed
Shah, SA, Shankar, V, Churchwell, KB, et al. Clinical outcomes of 84 children with congenital heart disease managed with extracorporeal membrane oxygenation after cardiac surgery. ASAIO J 2005; 51: 504–507.CrossRefGoogle ScholarPubMed
Gupta, P, Robertson, MJ, Beam, B, et al. Relationship of ECMO duration with outcomes after pediatric cardiac surgery: a multi-institutional analysis. Minerva Anestesiol 2015; 81: 619–627.Google ScholarPubMed
Chow, G, Koirala, B, Armstrong, D, et al. Predictors of mortality and neurological morbidity in children undergoing extracorporeal life support for cardiac disease. Eur J Cardio-Thoracic Surg 2004; 26: 38–43. doi: 10.1016/j.ejcts.2004.04.010 CrossRefGoogle ScholarPubMed
Kane, DA, Thiagarajan, RR, Wypij, D, et al. Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 2010; 122: S241–S248. doi: 10.1161/CIRCULATIONAHA.109.928390 CrossRefGoogle ScholarPubMed
Kumar, TKS, Zurakowski, D, Dalton, H, et al. Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome. J Thorac Cardiovasc Surg 2010; 140: 330–336.e2. doi: 10.1016/j.jtcvs.2010.02.034 CrossRefGoogle ScholarPubMed
Sasaki, T, Asou, T, Takeda, Y, Onakatomi, Y, Tominaga, T, Yamamoto, Y. Extracorporeal life support after cardiac surgery in children: outcomes from a single institution. Artif Organs 2014; 38: 34–40. doi: 10.1111/aor.12191 CrossRefGoogle ScholarPubMed
Flórez, CX, Bermon, A, Castillo, VR, Salazar, L. Setting up an ECMO program in a South American country. World J Pediatr Congenit Hear Surg 2015; 6: 374–381. doi: 10.1177/2150135115589788 CrossRefGoogle Scholar
Vidmar, I, Primožić, J, Kalan, G, Grosek, Š. Extracorporeal membranous oxygenation (ECMO) in neonates and children experiences of a multidisciplinary paediatric intensive care unit. Signa Vitae – A J Intensive Care Emerg Med 2017; 3: 17–21. doi: 10.22514/sv31.022008.4 CrossRefGoogle Scholar