Extracorporeal membrane oxygenation in pediatric patients: our experience in the last ten years.

BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) in children after cardiac surgery is well established. ECMO support is becoming an integral tool for cardiopulmonary resuscitation in specified centers.

OBJECTIVES: To review our use of ECMO over a 10 year period.

METHODS: All children supported with ECMO from 2000 to 2010 were reviewed. Most of these children suffered from cardiac anomalies. The patients were analyzed by age, weight, procedure, RACHS-1 when appropriate, length of support, and outcome.

RESULTS: Sixty-two children were supported with ECMO; their median age was 3 months (range 0-216 months) and median weight 4.3 kg (range 1.9-51 kg). Thirty-four patients (52.3%) needed additional hemofiltration or dialysis due to renal failure. The children requiring ECMO support represented a wide spectrum of cardiac lesions; the most common procedure was arterial switch operation (27.4%, n=17). ECMO was required mainly for failure to separate from the heart-lung machine (n=55). The median duration of ECMO support was 4 days (range 1-14 days); 29 (46.7%) patients were weaned successfully from ECMO during this time period, and 5 of them died during hospitalization, yielding an overall hospital survival rate of 38.7%.

CONCLUSIONS: ECMO support has significant survival benefit for patients with post-cardiotomy heart failure. Its early deployment should be considered in cardiopulmonary resuscitation.