20-Year Experience of Prolonged Extracorporeal Membrane Oxygenation in Critically Ill Children With Cardiac or Pulmonary Failure

Gupta, Punkaj; McDonald, Rachel; Chipman, Carl W.; Stroud, Michael H.; Gossett, Jeffrey M.; Imamura, Michiaki; Bhutta, Adnan T.

doi:10.1016/j.athoracsur.2012.01.008

Cited by 87 publications

(63 citation statements)

References 32 publications

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“…However, functional cardiac physiology (univentricular or biventricular), ECMO indications, and duration of ECMO were not found to be associated with an increased risk of mortality. On the other hand, in a recent study, Gupta et al [22] reported that prolonged ECMO support was associated with low survival rates. Consistent with the aforementioned study, although there was no significant difference in duration of ECMO, those who survived had a shorter period of ECMO support in our study.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation support after pediatric cardiac surgery: our single-center experience

Yüksel¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada, pediyatrik açık kalp cerrahisi sonrası mekanik destek gereken hastalarda beş yıllık ekstrakorporeal membran oksijenasyonu deneyimimiz sunuldu.Ça lış mapla nı:Şubat 2010 -Mart 2015 tarihleri arasında açık kalp cerrahisi yapılan ve postkardiyotomi dolaşım yetmezliği nedeniyle ekstrakorporeal membran oksijenasyonu desteği gereken 29 çocuğun (16 erkek, 13 kız; ort. yaş 21.6 ay; dağılım 5 gün-162 ay) tıbbi kayıtları retrospektif olarak incelendi. Bul gu lar:En sık tanı, sekiz hastada (%27.5) Fallot tetralojisi idi. En sık ekstrakorporeal membran oksijenasyonu endikasyonu, 12 hastada (%41) kardiyopulmoner baypastan ayrılmada yetersizlik idi. Ortalama ekstrakorporeal membran oksijenasyonu destek süresi 6.9 gündü (dağılım 14 saat-32 gün). En sık görülen ekstrakorporeal membran oksijenasyonu ile ilişkili komplikasyon, 14 hastada (%48.3) böbrek yetmezliği idi. On dört hasta (%48.3) başarıyla ekstrakorporeal membran oksijenasyonu desteğinden ayrılırken, altı hasta (%20.7) herhangi bir nörolojik sekel olmaksızın hastaneden taburcu edildi. Hiç bir anlamlı bir mortalite öngördürücüsü bulunmadı. Kardiyopulmoner baypastan ayrılmada yetersizlik, diğer ekstrakorporeal membran oksijenasyonu endikasyonlarına kıyasla, daha iyi sonuçlar ile neticelendi.So nuç: Ekstrakorporeal membran oksijenasyonu, pediyatrik açık kalp cerrahisi sonrasında etkili bir kardiyopulmoner desteği sağlar. Dikkatli hasta seçimi ve ekstrakorporeal membran oksijenasyonu için doğru zamanlama ve uygun tedavi optimum sonuçlar için çok önemlidir.Anah tar söz cük ler: Ekstrakorporeal membran oksijenasyonu; mekanik destek; pediyatrik kalp cerrahisi; postkardiyotomi dolaşım yetmezliği; venoarteriyel. ABSTRACTBackground:In this study, we present our five-year extracorporeal membrane oxygenation experiences in patients requiring mechanical support after pediatric open heart surgery.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation support after pediatric cardiac surgery: our single-center experience

Yüksel¹

2017

Turk Gogus Kalp Dama

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“…Gupta et al in their study related to children with acute respiratory and cardiac failure reports that in cases that were treated with ECMO duration within 28 days and above the incidence of 4 and more organ dysfunctions was encountered in 69%. Moreover, they observed neurological deficits in more than half of their patients, thromboembolic and hemorrhagic complications were observed as 25% and 37%, respectively (14). According to study conducted by Hintz et al (15) and Aharon et al (16), the critical duration for decent survival of children who underwent cardiac surgery was provision of 3 days or below ECMO support.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Extracorporeal Membrane Oxygenation In Pediatric Cardiac Surgery: A Single Center Experience, 34 Cases in 8 Years

Zeybek

Avsar

Yildirim³

et al. 2017

Iran J Pediatr

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Background: Extracorporeal membrane oxygenation (ECMO) is used in a variety of indications worldwide. One of the most important subsets is postoperative congenital cardiac surgery cases unresponsive to conventional therapies. In this study, we present our ECMO experience in a single congenital cardiac surgery center. Methods: ECMO was used in a total of 34 postoperative congenital cardiac surgery cases, whose operations had been performed by the same congenital cardiac surgery team. Patients' ages were between 3 days to 15 years. ECMO was used in four different indications; in case of unsuccessful weaning from cardiopulmonary bypass (OR-ECMO), in low cardiac output syndrome (LCOS-ECMO), in refractory post cardiac arrest (CPR-ECMO) and in respiratory insufficiency after RSV infection (RSV-ECMO). Results: The follow-up period of patients ranged from 1 to 80 months, whereas ECMO duration ranged from 23 to 2218 hours. Six cases were OR-ECMO, 13 were LCOS-ECMO, 12 were CPR-ECMO and 3 were RSV-ECMO. Out of a total of 34 cases, 20 (58%) cases were weaned from ECMO. Two of the patients, who were able to be weaned from ECMO passed away in the hospital; however, the other 18 patients (52.9%) were discharged from the hospital without having any significant neurological deficits. The top survival rate (69%) and weaning from ECMO was in the LCOS-ECMO group and the worst weaning from ECMO support (33%) was in the RSV-ECMO. The worst survival rate (25%) was in the CPR-ECMO group. Sepsis and associated multiple organ dysfunction were observed as the major cause of mortality in these patients. The most common complications were bleeding and mechanical complications related to cannulation. Conclusions: ECMO may be required in postoperative congenital cardiac surgery cases in whom all other conventional therapies have failed. Indications, timing and maintenance of equipment are very important points in successful ECMO management. Increasing ECMO experience in the near future, will provide much decrease in mortality of congenital cardiac surgery.

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“…1. 13 C from [5,6,[7][8][9][10][11][12][13] C3]heptanoate metabolizes to CAC without the conversion to acetyl-CoA, and these data were used for analysis of the anaplerotic component to the CAC. NMR data were acquired on a Varian Direct Drive (VNMRS) 600-MHz spectrometer (Agilent Technologies) equipped with a Dell Precision T3500 Linux workstation running VNMRJ 3.2.…”

Section: Methodsmentioning

confidence: 99%

“…However, mortality and morbidity remain high, with in-hospital mortality exceeding 50%. Duration of ECMO appears as a primary determinant of survival (5,20). Inability to wean from the circuit due to persistent cardiac dysfunction prolongs the circuit run.…”

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confidence: 99%

Differential effects of octanoate and heptanoate on myocardial metabolism during extracorporeal membrane oxygenation in an infant swine model

Kajimoto¹,

Ledee²,

Olson

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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]leucine) were systemically infused as metabolic markers for the final 60 min before left ventricular tissue extraction. Extracted tissues were analyzed for the 13 C-labeled and absolute concentrations of metabolites by nuclear magnetic resonance and gas chromatography-mass spectrometry. Octanoate produced markedly higher myocardial citrate concentration, and led to a higher [ATP]-to-[ADP] ratio compared with other groups. Unexpectedly, octanoate and heptanoate increased the flux of propionyl-CoA relative to acetyl-CoA into the CAC compared with control. MCFAs promoted increases in leucine oxidation, but were not associated with a difference in protein synthesis rate. In conclusion, octanoate provides energetic advantages to the heart over heptanoate. cardiac metabolism; extracorporeal circulation; fatty acids; pediatrics NEW & NOTEWORTHYOctanoate, an even-numbered medium-chain fatty acid, provides some energetic advantage for the heart, over odd-numbered heptanoate, during ventricular unloading by extracorporeal membrane oxygenation.

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20-Year Experience of Prolonged Extracorporeal Membrane Oxygenation in Critically Ill Children With Cardiac or Pulmonary Failure

Cited by 87 publications

References 32 publications

Extracorporeal membrane oxygenation support after pediatric cardiac surgery: our single-center experience

Extracorporeal membrane oxygenation support after pediatric cardiac surgery: our single-center experience

Utilization of Extracorporeal Membrane Oxygenation In Pediatric Cardiac Surgery: A Single Center Experience, 34 Cases in 8 Years

Differential effects of octanoate and heptanoate on myocardial metabolism during extracorporeal membrane oxygenation in an infant swine model

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