Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support

Sendhil K. Balasubramanian, Ravindranath Tiruvoipati, Mohammed Amin, Kanakkande K. Aabideen, Giles J. Peek, Andrew W. Sosnowski, Richard K. Firmin

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: Veno-arterial extracorporeal membrane oxygenation (ECMO) is a common modality of circulatory assist device used in children. We assessed the outcome of children who had ECMO following repair of congenital cardiac defects (CCD) and identified the risk factors associated with hospital mortality. Methods: From April 1990 to December 2003, 53 patients required ECMO following surgical correction of CCD. Retrospectively collected data was analyzed with univariate and multivariate logistic regression analysis. Results: Median age and weight of the patients were 150 days and 5.4 kgs respectively. The indications for ECMO were low cardiac output in 16, failure to wean cardiopulmonary bypass in 13, cardiac arrest in 10 and cardio-respiratory failure in 14 patients. The mean duration of ECMO was 143 hours. Weaning off from ECMO was successful in 66% and of these 83% were survival to hospital-discharge. 37.7% of patients were alive for the mean follow-up period of 75 months. On univariate analysis, arrhythmias, ECMO duration >168 hours, bleeding complications, renal replacement therapy on ECMO, arrhythmias and cardiac arrest after ECMO were associated with hospital mortality. On multivariate analysis, abnormal neurology, bleeding complications and arrhythmias after ECMO were associated with hospital mortality. Extra and intra-thoracic cannulations were used in 79% and 21% of patients respectively and extra-thoracic cannulation had significantly less bleeding complications (p = 0.031). Conclusion: ECMO provides an effective circulatory support following surgical repair of CCD in children. Extra-thoracic cannulation is associated with less bleeding complications. Abnormal neurology, bleeding complications on ECMO and arrhythmias after ECMO are poor prognostic indicators for hospital survival.

Original languageEnglish (US)
Article number4
JournalJournal of Cardiothoracic Surgery
Volume2
Issue number1
DOIs
StatePublished - Jan 11 2007
Externally publishedYes

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Extracorporeal Membrane Oxygenation
Pediatrics
Cardiac Arrhythmias
Hemorrhage
Hospital Mortality
Catheterization
Thorax
Neurology
Heart Arrest
Low Cardiac Output
Renal Replacement Therapy
Survival
Weaning
Cardiopulmonary Bypass
Respiratory Insufficiency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support. / Balasubramanian, Sendhil K.; Tiruvoipati, Ravindranath; Amin, Mohammed; Aabideen, Kanakkande K.; Peek, Giles J.; Sosnowski, Andrew W.; Firmin, Richard K.

In: Journal of Cardiothoracic Surgery, Vol. 2, No. 1, 4, 11.01.2007.

Research output: Contribution to journalArticle

Balasubramanian, Sendhil K. ; Tiruvoipati, Ravindranath ; Amin, Mohammed ; Aabideen, Kanakkande K. ; Peek, Giles J. ; Sosnowski, Andrew W. ; Firmin, Richard K. / Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support. In: Journal of Cardiothoracic Surgery. 2007 ; Vol. 2, No. 1.
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abstract = "Background: Veno-arterial extracorporeal membrane oxygenation (ECMO) is a common modality of circulatory assist device used in children. We assessed the outcome of children who had ECMO following repair of congenital cardiac defects (CCD) and identified the risk factors associated with hospital mortality. Methods: From April 1990 to December 2003, 53 patients required ECMO following surgical correction of CCD. Retrospectively collected data was analyzed with univariate and multivariate logistic regression analysis. Results: Median age and weight of the patients were 150 days and 5.4 kgs respectively. The indications for ECMO were low cardiac output in 16, failure to wean cardiopulmonary bypass in 13, cardiac arrest in 10 and cardio-respiratory failure in 14 patients. The mean duration of ECMO was 143 hours. Weaning off from ECMO was successful in 66{\%} and of these 83{\%} were survival to hospital-discharge. 37.7{\%} of patients were alive for the mean follow-up period of 75 months. On univariate analysis, arrhythmias, ECMO duration >168 hours, bleeding complications, renal replacement therapy on ECMO, arrhythmias and cardiac arrest after ECMO were associated with hospital mortality. On multivariate analysis, abnormal neurology, bleeding complications and arrhythmias after ECMO were associated with hospital mortality. Extra and intra-thoracic cannulations were used in 79{\%} and 21{\%} of patients respectively and extra-thoracic cannulation had significantly less bleeding complications (p = 0.031). Conclusion: ECMO provides an effective circulatory support following surgical repair of CCD in children. Extra-thoracic cannulation is associated with less bleeding complications. Abnormal neurology, bleeding complications on ECMO and arrhythmias after ECMO are poor prognostic indicators for hospital survival.",
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