Extracorporeal membrane oxygenation circulatory support after congenital cardiac surgery

Abstract

Extracorporeal membrane oxygenation (ECMO) is widely used for circulatory support in pediatric cardiac patients with low cardiac output and hypoxemia after cardiac surgery. We evaluated retrospectively, the efficacy of postoperative ECMO support following congenital cardiac surgery in our hospital. From April 2002 to February 2008, seven patients (median age 30 months) received postoperative mechanical support. Three had complete repair including Fontan circulation and four had palliative repair. In four patients, ECMO was initiated in the operating room, in three patients in the intensive care unit, postoperatively. Of the seven patients, one died on ECMO (support withdrawn), one died shortly after ECMO was discontinued, and five were successfully weaned and survived to hospital discharge. One of the survivors died 4 months after the operation due to pneumonia and septic shock. The mean duration of ECMO support was 121 hours (in survivors). During ECMO, the major complication was bleeding, despite adequate control of activated clotting time. We conclude that ECMO support for heart failure and respiratory insufficiency after congenital cardiac surgery was effective, and the result of ECMO support for respiratory insufficiency was better than for heart failure.