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Stanley Ziomek
James E. Harrell, Jr
Elizabeth Frazier
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Ann Thorac Surg 1992;54:861-868
© 1992 The Society of Thoracic Surgeons

Articles

Extracorporeal membrane oxygenation for cardiac failure after congenital heart operation

Stanley Ziomek, MD, James E. Harrell, Jr, MD, James W. Fasules, MD, Sherry C. Faulkner, CCP, Carl W. Chipman, RN, Michele Moss, MD, Elizabeth Frazier, MD, Stephen H. Van Devanter, MD*

Departments of Cardiothoracic Surgery and Pediatric Cardiology, David M. Clark Cardiovascular Center, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

* Address reprint requests to Dr Van Devanter, Department of Cardiothoracic Surgery, Arkansas Children's Hospital, 800 Marshall, Little Rock, AR 72202.

Despite continuing improvement in myocardial protection and surgical technique, the repair of complex congenital heart lesions can result in cardiopulmonary compromise refractory to conventional therapy. In a 29-month period, 24 patients (aged 14 hours to 6 years) were treated with extracorporeal membrane oxygenation (ECMO) 28 times for profound cardiopulmonary failure. Four patients required ECMO after each of two cardiopulmonary bypass procedures. Seventeen patients required ECMO to be initiated in the operating room: 12 (71%) were weaned successfully from ECMO, and 8 (47%) survived. Seven patients had ECMO initiated in the intensive care unit: 6 (86%) were weaned, and 5 (71%) survived. Serial echocardiograms demonstrated substantial recovery of cardiac function in 18 of 21 instances (86%) of ventricular failure from myocardial dysfunction. Overall, 18 of 24 patients (75%) were successfully weaned from ECMO including all 4 who underwent 2 ECMO treatments. We conclude that ECMO can successfully salvage children who have serious cardiopulmonary failure immediately after a congenital heart operation and that long-term survival is possible after two ECMO treatments.




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