ABSTRACT 773

Abstract

Background and aims: In Belgium, 4 pediatric cardiac centers offer pump cardiac surgery to less than 200 children/center/year. Ecmo is available in each. Aims: As it is now recognized that size matters, we wanted to analyze our results in providing ECMO to patients admitted in PICU, compare them to the literature and identify improvable factors. Methods: We retrospectively reviewed patients supported with ECMO in our PICU between January 2003 and December 2013. We analyzed indications, patient’s characteristics, ECMO course and outcome. Results: 44 children (median age 0.2 year (0.003-10.2) and weight 3.9 kg (2.2–25.0)) were supported with ECMO. ECMO was started after cardiac pump surgery in 32 (73%) and for respiratory or multiple organ failure in 12 (27%). Median duration of ECMO was 4 days (0–21). 38.6% of patients (13/32, 4/12) were weaned off ECMO, 31.8% (11/32, 3/12) leaved PICU and 27.3% (10/32, 2/12) were alive in December 2013. Deceased patients had significant higher initial (8.8 mMol/L +/- 5.2 vs 4.6 +/- 3.3, p= 0.021) and maximal lactate (9.6 mMol/L +/- 5.5 vs 5.3+/- 3.9, p=0.023). Hemorrhage was the most frequent complication (48.8% of cases) and tended to be associated with mortality (53.3% in deceased patients vs 28.6% in survivors, p=0.07). In deceased patients, 37% died after withdraw for neurological reason. Conclusions: Compared to high volume centers, our ECMO patients encountered more complications and higher mortality. We probably keep ECMO for most severe patients. As long as there will be no possibility to centralize pediatric cardiac surgery, we should try to optimize technique and improve selection.