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Delayed extracorporeal membrane oxygenation in children after cardiac surgery: two-institution experience

Published online by Cambridge University Press:  17 December 2013

Punkaj Gupta*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, United States of America
Rahul DasGupta
Affiliation:
Department of Anesthesia, Division of Pediatric Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, United States of America
Derek Best
Affiliation:
Department of Pediatric Intensive Care, The Royal Children’s Hospital, Melbourne, Australia
Craig B. Chu
Affiliation:
Department of Pediatrics, Pediatric Residency Program, University of Arkansas for Medical Sciences, United States of America
Hassan Elsalloukh
Affiliation:
Department of Mathematics and Statistics, University of Arkansas, United States of America
Jeffrey M. Gossett
Affiliation:
Department of Pediatrics, Division of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, United States of America
Michiaki Imamura
Affiliation:
Department of Pediatric Cardiothroacic Surgery, University of Arkansas for Medical Sciences, Little Rock, United States of America
Warwick Butt
Affiliation:
Department of Pediatric Intensive Care, The Royal Children’s Hospital, Melbourne, Australia
*
Correspondence to: P. Gupta, Assistant Professor of Pediatrics, Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, College of Medicine, Sections of Pediatric Cardiology and Critical Care Medicine, Arkansas Children’s Hospital, 1 Children’s Way, Slot 512-3, Little Rock, Arkansas, United States of America. Tel: (501) 364-1479; Fax: (501) 364-3667; E-mail: pgupta2@uams.edu

Abstract

Objective: There are limited data on the outcomes of children receiving delayed (≥7 days) extracorporeal membrane oxygenation after cardiac surgery. The primary aim of this project is to identify the aetiology and outcomes of extracorporeal membrane oxygenation in children receiving delayed (≥7 days) extracorporeal membrane oxygenation after cardiac surgery. Patients and methods: We conducted a retrospective review of all children ≤18 years supported with delayed extracorporeal membrane oxygenation after cardiac surgery between the period January, 2001 and March, 2012 at the Arkansas Children’s Hospital, United States of America, and Royal Children’s Hospital, Australia. The data collected in our study included patient demographic information, diagnoses, extracorporeal membrane oxygenation indication, extracorporeal membrane oxygenation support details, medical and surgical history, laboratory, microbiological, and radiographic data, information on organ dysfunction, complications, and patient outcomes. The outcome variables evaluated in this report included: survival to hospital discharge and current survival with emphasis on neurological, renal, pulmonary, and other end-organ function. Results: During the study period, 423 patients undergoing cardiac surgery were supported with extracorporeal membrane oxygenation at two institutions, with a survival of 232 patients (55%). Of these, 371 patients received extracorporeal membrane oxygenation <7 days after cardiac surgery, with a survival of 205 (55%) patients, and 52 patients received extracorporeal membrane oxygenation ≥7 days after cardiac surgery, with a survival of 27 (52%) patients. The median duration of extracorporeal membrane oxygenation run for the study cohort was 5 days (interquartile range: 3, 10). In all, 14 patients (25%) received extracorporeal membrane oxygenation during active cardiopulmonary resuscitation with chest compressions. There were 24 patients (44%) who received dialysis while being on extracorporeal membrane oxygenation. There were eight patients (15%) who had positive blood cultures and four patients (7%) who had positive urine cultures while being on extracorporeal membrane oxygenation. There were nine patients (16%) who had bleeding complications associated with extracorporeal membrane oxygenation runs. There were 10 patients (18%) who had cerebrovascular thromboembolic events associated with extracorporeal membrane oxygenation runs. Of these, 19 patients are still alive with significant comorbidities. Conclusions: This study demonstrates that mortality outcomes are comparable among children receiving extracorporeal membrane oxygenation ≥7 days and <7 days after cardiac surgery. The proportion of patients receiving extracorporeal membrane oxygenation ≥7 days is small and the aetiology diverse.

Type
Original Articles
Copyright
Copyright &#x00A9; Cambridge University Press 2013 

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