Article Text

CARDIAC ECMO IN A MEDIUM SIZED CONGENITAL CARDIAC CENTRE
  1. C Neeleman1,
  2. A Backx2,
  3. A Nijveld3,
  4. S Singh3,
  5. B Arnold4,
  6. J G van der Hoeven1,
  7. A van Heijst5
  1. 1Paediatric Cardiac Intensive Care Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
  2. 2Paediatric Cardiology Department, Radboud University Medical Centre, Nijmegen, The Netherlands
  3. 3Paediatric Cardiac Surgery Department, Radboud University Medical Centre, Nijmegen, The Netherlands
  4. 4Paediatric Cardiac Anaesthesiology Department, Radboud University Medical Centre, Nijmegen, The Netherlands
  5. 5Neonatology Department, Radboud University Medical Centre, Nijmegen, The Netherlands

Abstract

Objective Mechanical circulatory support is an essential component of complex pediatric cardiac surgery programs. ECMO provides circulatory and respiratory support and has an advantage over VAD in neonates where cardiac dysfunction is often combined with pulmonary failure. In our institution cardiac ECMO is provided since 1996 and used as a bridge to recovery in failure to wean from CPB. In the present study we analyzed the results of postoperative cardiac ECMO support in our congenital cardiac centre (300 admissions a year) over a 11 year period (1996–2007).

Methods Cardiac ECMO runs were performed on the facility of the neonatal intensive care unit (NICU) in close cooperation with the experienced neonatal staff. All patients were cannulated transthoracic right atrium-ascending aorta in the operating theatre.

Results During the study period 26 out of 3250 postcardiotomy pediatric patients (0.8%) were put on ECMO support; 23 patients because of failure to wean from cardiopulmonary bypass (CBP), 2 patients because of cardiopulmonary failure in the early postoperative period and 1 patient 15 hrs postpartum with infradiaphragmatic TAPVC. In the latter patient surgical repair was performed on ECMO support. Age ranged from 1 day to 3.9 years; weight from 2.7 to 16 kg. 21 out of 26 patients (81%) were successfully weaned from ECMO whereas 11 patients (42%) survived through hospital discharge. The median duration of support was 117 hours (range 8–433 hrs

Conclusions Hospital survival of cardiac ECMO in our institution (42%) is in line with survival rates reported in the ELSO registry.

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