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Vinod H. Thourani
Paul M. Kirshbom
Kirk R. Kanter
Janet Simsic
Brian E. Kogon
Joseph M. Forbess
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Right arrow Extracorporeal circulation

Ann Thorac Surg 2006;82:138-145
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) in Pediatric Cardiac Support

Vinod H. Thourani, MD a , Paul M. Kirshbom, MD a , Kirk R. Kanter, MD a , Janet Simsic, MD c , Brian E. Kogon, MD a , Scott Wagoner, RTT e , Francine Dykes, MD b , e , James Fortenberry, MD d , e , Joseph M. Forbess, MD a , *

a Joseph B. Whitehead Department of Surgery, Section of Pediatric Cardiothoracic Surgery, Atlanta, Georgia
b Division of Neonatology, Atlanta, Georgia
c Division of Cardiology in the Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
d The Division of Critical Care Medicine at Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
e The ECMO and Advanced Technologies Center at Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia

Accepted for publication February 4, 2006.

* Address correspondence to Dr Forbess, UT Southwestern Medical Center, Children's Medical Center, Dallas, TX 75235 (Email: joseph.forbess{at}utsouthwestern.edu).

Presented at the Fifty-first Annual Meeting of the Southern Thoracic Surgical Association, Cancun, Mexico, Nov 2–4, 2004.

BACKGROUND: Resuscitation extracorporeal membrane oxygenation (R-ECMO) was introduced at our institution in July 2002. We reviewed the use of venoarterial (VA)-ECMO for cardiac diagnoses at our institution.

METHODS: Retrospective analysis of patients on VA-ECMO for cardiac failure was performed. Survival was defined as discharge from hospital.

RESULTS: Twenty-seven patients were supported with VA-ECMO (median age, 27 days; range, 1 to 640 days; median weight, 3.8 kg; range, 1.8 to 11.3 kg). Diagnoses were cardiomyopathy-myocarditis (CMM) in 8 (30%), systemic-to-pulmonary artery shunt-dependent single ventricle (SV) in 12 (44%), postcardiotomy for biventricular repair (BiV) in 6 (22%), and arrhythmia in 1 (4%). Sixteen of 27 patients survived (59%). Seven of 8 CMM patients survived (88%); 6 (75%) bridged to cardiac recovery, 1 to transplant (13%), and 1 death (13%). Seven of 12 SV patients survived (58%). The SV ECMO indications: post-Norwood ventricular dysfunction (n = 3, 2 deaths), postoperative cardiac failure (n = 6, 2 deaths), respiratory failure (n = 1, 1 death), and acute shunt occlusion (n = 2, 0 deaths). One of 6 BiV patients survived (17%). The BiV ECMO indications: failure to wean from CPB (n = 3, 3 deaths), postoperative cardiac failure (n = 2, 2 deaths), and pulmonary hypertension (n = 1, 0 deaths). Fifteen patients (56%) underwent cardiopulmonary resuscitation during ECMO cannulation. Eleven of 15 R-ECMO patients (73%) survived versus 5 of 12 non-R-ECMO patients (42%, p = 0.13). Median duration of R-ECMO: 66 hours (range, 18 to 179) versus 145 hours (range, 43 to 986, p = 0.01) for non-R-ECMO.

CONCLUSIONS: Resuscitation extracorporeal membrane oxygenation is an appropriate application in pediatric patients with cardiac disease. Single ventricle patients experiencing cardiopulmonary collapse and CMM patients have favorable outcomes. Failure to wean from CPB and postoperative ventricular failure are higher risk indications.




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