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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 27-35, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
KR Kanter, G Pennington, TR Weber, MA Zambie, P Braun and V Martychenko
Prolonged circulatory support for cardiac failure has been increasingly
successful in adults but has had very limited use in children. From January
1982 to December 1985, 13 children with postoperative cardiac failure
refractory to conventional therapy were treated with extracorporeal
membrane oxygenation. Ages ranged from 9 days to 17.6 years (mean = 3.8
years); weights ranged from 2.8 to 50 kg (mean = 13.8 kg). Seven patients
had obstructive lesions of the right ventricle, such as pulmonary stenosis
and tetralogy; the other patients had tricuspid atresia, truncus
arteriosus, complete transposition, total anomalous pulmonary venous
connection, pericardial tamponade, and a drug reaction after heart
transplantation. One patient (nonsurvivor), who could not be separated from
cardiopulmonary bypass, required extracorporeal membrane oxygenation in the
operating room. In the remaining 12, the interval between operation and the
start of extracorporeal membrane oxygenation ranged from 9 to 50 hours
(mean = 22.2 hours). Four patients were cannulated through the groin and
nine through the chest. Peak flows ranged from 1.05 to 2.74 L/min/m2 (mean
1.92 L/min/m2). Duration of oxygenator support ranged from 12 hours to 9
days (mean = 3.4 days). Seven patients required reexploration for bleeding.
Renal insufficiency developed in five patients, four of whom underwent
hemodialysis or ultrafiltration during extracorporeal membrane oxygenation.
Two patients had evidence of clots in the oxygenator circuit. Seven
patients were weaned from extracorporeal membrane oxygenation. Failure to
wean from the oxygenator was related to neurologic sequelae of prolonged
hypotension before institution of oxygenation in three patients.
Mediastinitis developed in three of the seven patients who were weaned. One
of these three died in the hospital 74 days after being weaned from the
oxygenator. There has been one late death 6 months after oxygenator support
was withdrawn. At most recent examination, five children were well, with
normal cardiac function 7 months to 4.3 years postoperatively (mean = 32
months). This series suggests that profound cardiac insufficiency in
children after cardiac operations can be successfully managed with
extracorporeal membrane oxygenation with excellent functional recovery,
although major complications are common in this critically ill group of
patients.
ARTICLES
Extracorporeal membrane oxygenation for postoperative cardiac support in children
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