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Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome*

Ravishankar, Chitra MD; Dominguez, Troy E. MD; Kreutzer, Jacqueline MD; Wernovsky, Gil MD; Marino, Bradley S. MD, MSCE; Godinez, Rodolfo MD, PhD; Priestley, Margaret A. MD; Gruber, Peter J. MD, PhD; Gaynor, William J. MD; Nicolson, Susan C. MD; Spray, Thomas L. MD; Tabbutt, Sarah MD, PhD

Pediatric Critical Care Medicine: July 2006 - Volume 7 - Issue 4 - p 319-323
doi: 10.1097/01.PCC.0000227109.82323.CE
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Objective: Although extracorporeal membrane oxygenation (ECMO) is an acceptable strategy for children with refractory cardiac dysfunction after cardiac surgery, its role after stage I reconstruction for hypoplastic left heart syndrome and its variants is controversial. Our objective is to describe the outcome of “nonelective” ECMO after stage I reconstruction.

Design: Retrospective case series.

Setting: Pediatric cardiac intensive care unit.

Patients: Infants placed on ECMO after stage I reconstruction from January 1998 to May 2005.

Interventions: None.

Measurements and Main Results: Of the 382 infants who underwent stage I reconstruction during the study period, 36 (9.4%) required ECMO in the postoperative period. There were 22 infants with hypoplastic left heart syndrome. Indications for ECMO included inability to separate from cardiopulmonary bypass in 14 and cardiac arrest in 22. Fourteen infants (38.8%) survived to hospital discharge. Nonsurvivors had longer cardiopulmonary bypass time (150.1 ± 70.0 mins vs. 103.9 ± 30.0 mins, p =. 01). 9/14 infants (64%) supported with ECMO> than 24 hrs after stage I reconstruction survived while only 5/22 infants (22%) requiring ECMO< 24 hrs of stage I reconstruction survived (p =. 02). Of note, all five infants diagnosed with an acute shunt thrombosis were early survivors. Mean duration of ECMO was 50.1 ± 12.5 hrs for survivors and 125.2 ± 25.0 for nonsurvivors (p =. 01). 7/14 early survivors are alive at a median follow-up of 20 months (2–78 months).

Conclusions: In our experience, ECMO after stage I reconstruction can be life saving in about a third of infants with otherwise fatal conditions. It is particularly useful in potentially reversible conditions such as acute shunt thrombosis and transient depression of ventricular function.

From the Division of Cardiology (CR, GW, BSM, ST), Department of Pediatrics; Division of Cardiothoracic Surgery (PJG, WJG, TLS), Department of Surgery; and Department of Anesthesiology and Critical Care Medicine (TED, BSM, RG, MAP, SCN, ST), The Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine; and the Division of Cardiology (JK), Department of Pediatrics, The Children’s Hospital of Pittsburgh.

The authors have not disclosed any potential conflicts of interest.

Address requests for reprints to: Chitra Ravishankar, MD, Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104–4399. E-mail: Ravishankar@email.chop.edu.

©2006The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies