HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rogers, A. J. Articles by Fischer, D. R. Search for Related Content PubMed PubMed Citation Articles by Rogers, A. J. Articles by Fischer, D. R.

The Annals of Thoracic Surgery, Vol 47, 903-906, Copyright © 1989 by The Society of Thoracic Surgeons

ARTICLES

Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock in children

AJ Rogers, A Trento, RD Siewers, BP Griffith, RL Hardesty, E Pahl, LB Beerman, FJ Fricker and DR Fischer
Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania.

Size limitations and technical barriers prohibit the use of many conventional mechanical circulatory support systems for postcardiotomy ventricular dysfunction in pediatric populations. Extracorporeal membrane oxygenation (ECMO), frequently used to treat neonatal respiratory failure, can provide cardiac support and is effective treatment of postoperative myocardial failure in children. From 1981 to 1987, 10 patients aged 2 days to 5 years were maintained on ECMO for 15 to 144 hours (mean duration, 92 +/- 16 hours) after cardiotomy. Operative procedures included repair of tetralogy of Fallot (2 patients), closure of a ventricular septal defect (2), the Senning procedure for transposition of the great arteries (1 patient), repair of interrupted aortic arch with closure of a ventricular septal defect (1), repair of a partial atrioventricular septal defect (2), closure of a ventricular septal defect with excision of an anomalous muscle bundle (1), and the Fontan procedure (1). Venoarterial ECMO was established in all 10 children. Six patients underwent transthoracic right atrium- ascending aorta cannulation, 3 had right internal jugular vein-right common carotid artery cannulation through a cervical incision, and 1 had right internal jugular vein-left axillary artery cannulation. Eight of the 10 patients were successfully weaned from ECMO, and 7 are long- term survivors. There were 3 deaths; 1 was caused by cardiac and acute renal failure complicated by sepsis two days after decannulation, another occurred 19 days after atrioventricular septal defect repair, and 1 was caused by massive pulmonary hemorrhage. Major hemorrhage developed in 3 patients while on ECMO; 2 required premature decannulation for mediastinal bleeding from operative sites and ultimately survived, and 1 died of respiratory failure as a result of endobronchial bleeding. We conclude that the use of ECMO in pediatric populations for transient postoperative ventricular dysfunction improves survival with limited overall morbidity.

This article has been cited by other articles:

				K. L. Booth, S. J. Roth, R. R. Thiagarajan, M. C. Almodovar, P. J. del Nido, and P. C. Laussen Extracorporeal membrane oxygenation support of the Fontan and bidirectional Glenn circulations Ann. Thorac. Surg., April 1, 2004; 77(4): 1341 - 1348. [Abstract] [Full Text] [PDF]

				R. M. Ungerleider, I. Shen, T. Yeh Jr, J. Schultz, R. Butler, M. Silberbach, C. Giacomuzzi, E. Heller, L. Studenberg, B. Mejak, et al. Routine mechanical ventricular assist following the Norwood procedure--improved neurologic outcome and excellent hospital survival Ann. Thorac. Surg., January 1, 2004; 77(1): 18 - 22. [Abstract] [Full Text] [PDF]

				S. E. G. Hamrick, D. B. Gremmels, C. A. Keet, C. H. Leonard, J. K. Connell, S. Hawgood, and R. E. Piecuch Neurodevelopmental Outcome of Infants Supported With Extracorporeal Membrane Oxygenation After Cardiac Surgery Pediatrics, June 1, 2003; 111(6): e671 - 675. [Abstract] [Full Text] [PDF]

				A. Y. Schure, P. C. Laussen, and F. X. McGowan JR Mechanical Cardiopulmonary Support of Infants and Children With Congenital Heart Disease Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2001; 5(1): 46 - 54. [Abstract] [PDF]

				I. Shen, F. H. Levy, C. R. Vocelka, P. P. O'Rourke, B. W. Duncan, R. Thomas, and E. D. Verrier Effect of extracorporeal membrane oxygenation on left ventricular function of swine Ann. Thorac. Surg., March 1, 2001; 71(3): 862 - 867. [Abstract] [Full Text] [PDF]

				I. Shen, F. H. Levy, A. M. Benak, C. L. Rothnie, P. P. O'Rourke, B. W. Duncan, and E. D. Verrier Left ventricular dysfunction during extracorporeal membrane oxygenation in a hypoxemic swine model Ann. Thorac. Surg., March 1, 2001; 71(3): 868 - 871. [Abstract] [Full Text] [PDF]

				C. Pizarro, D.A. Davis, R.M. Healy, P.J. Kerins, and W.I. Norwood Is there a role for extracorporeal life support after stage I Norwood? Eur. J. Cardiothorac. Surg., March 1, 2001; 19(3): 294 - 301. [Abstract] [Full Text] [PDF]

				E. M. Darling, D. Kaemmer, D. S. Lawson, J. J. Jaggers, and R. M. Ungerleider Use of ECMO without the oxygenator to provide ventricular support after Norwood Stage I procedures Ann. Thorac. Surg., February 1, 2001; 71(2): 735 - 736. [Abstract] [Full Text] [PDF]

				J. J. Jaggers, J. M. Forbess, A. S. Shah, J. N. Meliones, P. M. Kirshbom, C. E. Miller, and R. M. Ungerleider Extracorporeal membrane oxygenation for infant postcardiotomy support: significance of shunt management Ann. Thorac. Surg., May 1, 2000; 69(5): 1476 - 1483. [Abstract] [Full Text] [PDF]

				S. M. Langley, S. V. Sheppard, V. T. Tsang, J. L. Monro, and R. K. Lamb When is extracorporeal life support worthwhile following repair of congenital heart disease in children? Eur. J. Cardiothorac. Surg., May 1, 1999; 13(5): 520 - 525. [Abstract] [Full Text] [PDF]

				V. J McKay, D. L Stewart, T. W Robinson, L. N Cook, and E. H Austin III Preoperative versus postoperative extracorporeal life support in neonatal cardiac patients Perfusion, May 1, 1997; 12(3): 179 - 186. [Abstract] [PDF]

				H. L. Walters III, M. Hakimi, M. D. Rice, J. M. Lyons, G. C. Whittlesey, and M. D. Klein Pediatric Cardiac Surgical ECMO: Multivariate Analysis of Risk Factors for Hospital Death Ann. Thorac. Surg., August 1, 1995; 60(2): 329 - 336. [Abstract] [Full Text]