Single-center experience of extracorporeal membrane oxygenation in children with biventricular physiology in the postoperative period

Abstract

Aim . To assess the efficacy and safety of venoarterial ECMO in the early postoperative period after congenital heart surgery in children with biventricular physiology, to evaluate the recovery of ventricular contractile function, and to determine predictors able to predict the outcome of treatment and the prognosis of the disease. Methods . 15 medical records of pediatric patients treated in the period from 2016 to 2018 were retrospectively reviewed in a single-center study. The short-term outcomes of venoarterial ECMO in the early postoperative period were examined. Patients aged 1 month to 18 years were selected for the study. The median age of patients undergoing congenital heart surgery was 5 months (from 1 month to 4 years). 60% of them were male. Results . ECMO was started in the postoperative period due to inability to go off-pump in 5 OR patients (33.3%), postoperative circulatory arrest in 4 patients (26.7%), and low cardiac output syndrome in 6 patients (40%). The median body weight was 5.7 kg (from 3.7 to 15.6 kg). 14 patients underwent biventricular surgery. One patient underwent palliative repair, and then was referred to the total repair. The mean cardiopulmonary bypass time was 103.6 (±62.3) minutes with the aortic cross-clamp time of 51.9 (±27.3) minutes. 12 patients (80%) were disconnected from ECMO. The overall hospital survival was 66.7% (10 patients). The mean duration of ECMO support in survivors was 118.4 (±37.5) hours. Conclusion . The survival of patients improves with the steeper learning curve. ECMO contributes to the improved ventricular contractile function. Prolonged ECMO increases the number of specific complications associated with the procedure and affects survival. Our single-center experience in pediatric ECMO is generally consistent with the national and global trends in the use of mechanical support for intensive care.