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Right arrow Congenital - cyanotic

Ann Thorac Surg 2004;78:1723-1727
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Venovenous Extracorporeal Membrane Oxygenation for Cyanotic Congenital Heart Disease

Michiaki Imamura, MD, PhDa, Michael L. Schmitz, MDb, Bryan Watkins, MDb, Carl W. Chipman, RNa, Sherry C. Faulkner, CCPa, William P. Fiser, Jr, MDa, Stephen H. Van Devanter, MDa, Jonathan J. Drummond-Webb, MDa,*

a Department of Pediatric and Congenital Heart Surgery, Little Rock, AR, USA
b Pediatric Cardiovascular Anesthesiology, Arkansas Children's Hospital, Little Rock, Arkansas, USA

Accepted for publication May 4, 2004.

* Address reprint requests to Dr Drummond-Webb, Department of Pediatric and Congenital Heart Surgery, Arkansas Children's Hospital, 800 Marshall St, Slot 677, Little Rock, AR 72202, USA

Presented at the Fiftieth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 13–15, 2003.

BACKGROUND: Severe, refractory hypoxemia complicating uncorrected cyanotic congenital heart disease is a potentially lethal condition, even when urgent surgical intervention is undertaken. When a viral pneumonia initiates hypoxemia, the likelihood of a satisfactory outcome is further reduced. We examined our policy of venovenous extracorporeal membrane oxygenation support through the hypoxic event and performing delayed surgery, if required, to separate from extracorporeal membrane oxygenation.

METHODS: A single institution, retrospective review of an Institutional Review Board approved database was undertaken. Over a 6-year period, 18 instances were identified for 17 patients who became acutely hypoxemic from either inadequate pulmonary blood flow (8 instances) or a viral pneumonia (10 instances) complicating their cyanotic heart disease. Demographics, duration of venovenous extracorporeal membrane oxygenation and outcomes are reported.

RESULTS: The length of venovenous extracorporeal membrane oxygenation ranged from 13.5 to 362.5 hours (mean 130 ± 121 hours). During 10 supports, operations were performed to facilitate weaning from support. In 7 patients, extracorporeal support was weaned during this surgery. Follow-up was obtained in all patients over a period ranging from 4 months to 7 years (mean 39.0 ± 23.0 months). There were two late deaths due to sepsis 1.4 and 2.5 months after extracorporeal support.

CONCLUSIONS: Venovenous extracorporeal membrane oxygenation allows time for the recovery of acute hypoxic insult and resolution of some viral pneumonia processes. Palliative surgical procedures may be safely undertaken during extracorporeal support. Viral pneumonia is a risk for prolonged support. Venovenous extracorporeal membrane oxygenation is useful in these high-risk patients.






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