Intraoperative extracorporeal membrane oxygenation and survival of pediatric patients undergoing repair of congenital heart disease

Randall Flick, Juraj Sprung, Stephen J. Gleich, Roxann D. Barnes, David Oman Warner, Joseph A. Dearani, Phillip D. Scott, Andrew C. Hanson, Darrell R. Schroeder, Gregory J. Schears

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: We studied the association between the introduction of extracorporeal membrane oxygenation (ECMO) into routine practice and the survival of children who failed weaning from cardiopulmonary bypass (CPB). We compare two periods, before formal introduction of ECMO in our institution (1993-1999, pre-ECMO era) and after ECMO became a formalized program (2000-2006, ECMO era). Methods: Retrospective review of Mayo Clinic Database between 1993 and 2006 for outcomes of patients <18 years old who required ECMO during repair of congenital heart malformations. Results: Thirty-five children during ECMO era received intraoperative ECMO, and 17 (54%) survived to hospital discharge. The frequency of ECMO use was the highest in neonates, therefore, this was the only subcohort of pediatric patients that allowed comparison of survival between the pre-ECMO and ECMO eras. When compared to pre-ECMO era, neonatal survival increased during ECMO era (P = 0.043). ECMO was mostly used in neonates with higher complexity of cardiac defects undergoing more complex repairs, and the overall improvement of survival was primarily due to better survival of these patients. During pre-ECMO era, survival was lower in patients with higher risk (P = 0.001). However, during ECMO era, no difference in survival was observed across assigned risk groups (P = 0.658). Conclusions: The availability of ECMO for neonates failing to wean from CPB was associated with improved survival, especially in children undergoing repair of the most complex congenital heart malformations. After introduction of ECMO, survival improved and no longer depended upon the complexity of surgical repair.

Original languageEnglish (US)
Pages (from-to)757-766
Number of pages10
JournalPaediatric Anaesthesia
Volume18
Issue number8
DOIs
StatePublished - Aug 2008

Fingerprint

Extracorporeal Membrane Oxygenation
Heart Diseases
Pediatrics
Survival
Congenital Heart Defects
Newborn Infant
Cardiopulmonary Bypass

Keywords

  • Cardiac operations: cardiopulmonary bypass
  • Extracorporeal membrane oxygenation: survival rates
  • Heart defects: congenital
  • Intraoperative complications: failure to wean
  • Pediatric patients: infants, neonates

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Intraoperative extracorporeal membrane oxygenation and survival of pediatric patients undergoing repair of congenital heart disease. / Flick, Randall; Sprung, Juraj; Gleich, Stephen J.; Barnes, Roxann D.; Warner, David Oman; Dearani, Joseph A.; Scott, Phillip D.; Hanson, Andrew C.; Schroeder, Darrell R.; Schears, Gregory J.

In: Paediatric Anaesthesia, Vol. 18, No. 8, 08.2008, p. 757-766.

Research output: Contribution to journalArticle

Flick, Randall ; Sprung, Juraj ; Gleich, Stephen J. ; Barnes, Roxann D. ; Warner, David Oman ; Dearani, Joseph A. ; Scott, Phillip D. ; Hanson, Andrew C. ; Schroeder, Darrell R. ; Schears, Gregory J. / Intraoperative extracorporeal membrane oxygenation and survival of pediatric patients undergoing repair of congenital heart disease. In: Paediatric Anaesthesia. 2008 ; Vol. 18, No. 8. pp. 757-766.
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abstract = "Background: We studied the association between the introduction of extracorporeal membrane oxygenation (ECMO) into routine practice and the survival of children who failed weaning from cardiopulmonary bypass (CPB). We compare two periods, before formal introduction of ECMO in our institution (1993-1999, pre-ECMO era) and after ECMO became a formalized program (2000-2006, ECMO era). Methods: Retrospective review of Mayo Clinic Database between 1993 and 2006 for outcomes of patients <18 years old who required ECMO during repair of congenital heart malformations. Results: Thirty-five children during ECMO era received intraoperative ECMO, and 17 (54{\%}) survived to hospital discharge. The frequency of ECMO use was the highest in neonates, therefore, this was the only subcohort of pediatric patients that allowed comparison of survival between the pre-ECMO and ECMO eras. When compared to pre-ECMO era, neonatal survival increased during ECMO era (P = 0.043). ECMO was mostly used in neonates with higher complexity of cardiac defects undergoing more complex repairs, and the overall improvement of survival was primarily due to better survival of these patients. During pre-ECMO era, survival was lower in patients with higher risk (P = 0.001). However, during ECMO era, no difference in survival was observed across assigned risk groups (P = 0.658). Conclusions: The availability of ECMO for neonates failing to wean from CPB was associated with improved survival, especially in children undergoing repair of the most complex congenital heart malformations. After introduction of ECMO, survival improved and no longer depended upon the complexity of surgical repair.",
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T1 - Intraoperative extracorporeal membrane oxygenation and survival of pediatric patients undergoing repair of congenital heart disease

AU - Flick, Randall

AU - Sprung, Juraj

AU - Gleich, Stephen J.

AU - Barnes, Roxann D.

AU - Warner, David Oman

AU - Dearani, Joseph A.

AU - Scott, Phillip D.

AU - Hanson, Andrew C.

AU - Schroeder, Darrell R.

AU - Schears, Gregory J.

PY - 2008/8

Y1 - 2008/8

N2 - Background: We studied the association between the introduction of extracorporeal membrane oxygenation (ECMO) into routine practice and the survival of children who failed weaning from cardiopulmonary bypass (CPB). We compare two periods, before formal introduction of ECMO in our institution (1993-1999, pre-ECMO era) and after ECMO became a formalized program (2000-2006, ECMO era). Methods: Retrospective review of Mayo Clinic Database between 1993 and 2006 for outcomes of patients <18 years old who required ECMO during repair of congenital heart malformations. Results: Thirty-five children during ECMO era received intraoperative ECMO, and 17 (54%) survived to hospital discharge. The frequency of ECMO use was the highest in neonates, therefore, this was the only subcohort of pediatric patients that allowed comparison of survival between the pre-ECMO and ECMO eras. When compared to pre-ECMO era, neonatal survival increased during ECMO era (P = 0.043). ECMO was mostly used in neonates with higher complexity of cardiac defects undergoing more complex repairs, and the overall improvement of survival was primarily due to better survival of these patients. During pre-ECMO era, survival was lower in patients with higher risk (P = 0.001). However, during ECMO era, no difference in survival was observed across assigned risk groups (P = 0.658). Conclusions: The availability of ECMO for neonates failing to wean from CPB was associated with improved survival, especially in children undergoing repair of the most complex congenital heart malformations. After introduction of ECMO, survival improved and no longer depended upon the complexity of surgical repair.

AB - Background: We studied the association between the introduction of extracorporeal membrane oxygenation (ECMO) into routine practice and the survival of children who failed weaning from cardiopulmonary bypass (CPB). We compare two periods, before formal introduction of ECMO in our institution (1993-1999, pre-ECMO era) and after ECMO became a formalized program (2000-2006, ECMO era). Methods: Retrospective review of Mayo Clinic Database between 1993 and 2006 for outcomes of patients <18 years old who required ECMO during repair of congenital heart malformations. Results: Thirty-five children during ECMO era received intraoperative ECMO, and 17 (54%) survived to hospital discharge. The frequency of ECMO use was the highest in neonates, therefore, this was the only subcohort of pediatric patients that allowed comparison of survival between the pre-ECMO and ECMO eras. When compared to pre-ECMO era, neonatal survival increased during ECMO era (P = 0.043). ECMO was mostly used in neonates with higher complexity of cardiac defects undergoing more complex repairs, and the overall improvement of survival was primarily due to better survival of these patients. During pre-ECMO era, survival was lower in patients with higher risk (P = 0.001). However, during ECMO era, no difference in survival was observed across assigned risk groups (P = 0.658). Conclusions: The availability of ECMO for neonates failing to wean from CPB was associated with improved survival, especially in children undergoing repair of the most complex congenital heart malformations. After introduction of ECMO, survival improved and no longer depended upon the complexity of surgical repair.

KW - Cardiac operations: cardiopulmonary bypass

KW - Extracorporeal membrane oxygenation: survival rates

KW - Heart defects: congenital

KW - Intraoperative complications: failure to wean

KW - Pediatric patients: infants, neonates

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