Original article
Pediatric cardiac
Preoperative Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Surgery in Children With Congenital Heart Disease

https://doi.org/10.1016/j.athoracsur.2009.06.074Get rights and content

Background

The efficacy of extracorporeal membrane oxygenation (ECMO) in bridging children with unrepaired heart defects to a definitive or palliative surgical procedure has been rarely reported. The goal of this study is to report our institutional experience with ECMO used to provide preoperative stabilization after acute cardiac or respiratory failure in patients with congenital heart disease before cardiac surgery.

Methods

A retrospective review of the ECMO database at Children's Hospital Boston was undertaken. Children with unrepaired congenital heart disease supported with ECMO for acute cardiac or respiratory failure as bridge to a definitive or palliative cardiac surgical procedure were identified. Data collection included patient demographics, indication for ECMO, details regarding ECMO course and complications, and survival to hospital discharge.

Results

Twenty-six patients (18 male, 8 female) with congenital heart disease were bridged to surgical palliation or anatomic repair with ECMO. Median age and weight at ECMO cannulation were, respectively, 0.12 months (range, 0 to 193) and 4 kg (range, 1.8 to 67 kg). Sixteen patients (62%) survived to hospital discharge. Variables associated with mortality included inability to decannulate from ECMO after surgery (p = 0.02) and longer total duration of ECMO (p = 0.02). No difference in outcomes was found between patients with single and biventricular anatomy.

Conclusions

Extracorporeal membrane oxygenation, used as a bridge to surgery, represents a useful modality to rescue patients with failing circulation and unrepaired complex heart defects.

Section snippets

Patients and Methods

Retrospective data collection for purposes of this study was approved by the Institutional Review Board at Children's Hospital Boston, and the need for informed consent was waived. We included patients placed on ECMO for preoperative stabilization and who remained on ECMO until their palliative or definitive cardiac surgical procedure. Patients supported with ECMO after an index cardiac surgical procedure and who had a subsequent surgical operation during ECMO support and those who used ECMO as

Study Population

From January 1996 to December 2008, we identified 26 CHD patients with refractory cardiopulmonary failure requiring ECMO support as a bridge to a cardiac surgical procedure. These 26 patients represent 6.5% of our total ECMO experience (442 ECMO uses in 399 patients) during the same period. Males constituted 69% of the cohort (n = 18). Median age at cannulation was 0.12 months (range, 0 to 193). At the time of cannulation 17 patients were neonates (less than 1 month of age) and 6 patients were

Comment

Although several reports have addressed the importance of ECMO support for low cardiac output, cardiac arrest, hypoxemia after cardiopulmonary bypass, or as a bridge to cardiac transplantation [5, 10, 11, 12, 13, 14, 15, 16], reports describing outcomes of patients undergoing ECMO cannulation for cardiopulmonary failure as a bridge to a cardiac surgical repair are rare. The present case series of 26 patients is the largest reported to date. Inability to decannulate and a long ECMO run after

References (22)

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