Venoarterial extracorporeal membrane oxygenation in heart surgery post-operative pediatric patients: A retrospective study at Christus Muguerza Hospital, Monterrey, Mexico

Abstract

Objectives: Extracorporeal membrane oxygenation is a life support procedure developed to offer cardiorespiratory support when conventional therapies have failed. The purpose of this study is to describe the findings during the first years using venoarterial extracorporeal membrane oxygenation in pediatric patients after cardiovascular surgery at Christus Muguerza High Specialty Hospital in Monterrey, Mexico. Methods: This is a retrospective, observational, and descriptive study. The files of congenital heart surgery post-operative pediatric patients, who were treated with venoarterial extracorporeal membrane oxygenation from January 2013 to December 2015, were reviewed. Results: A total of 11 patients were reviewed, of which 7 (63.8%) were neonates and 4 (36.7%) were in pediatric age. The most common diagnoses were transposition of great vessels, pulmonary stenosis, and tetralogy of Fallot. Survival rate was 54.5% and average life span was 6.3 days; the main complications were sepsis (36.3%), acute renal failure (36.3%), and severe cerebral hemorrhage (9.1%). The main causes of death were multi-organ dysfunction syndrome (27.3%) and cerebral hemorrhage (18.2%). Conclusion: The mortality rates found are very similar to those found in a meta-analysis report published in 2013 and the main complication and causes of death are also very similar to the majority of extracorporeal membrane oxygenation reports for these kinds of patients. Although the results are encouraging, early sepsis detection, prevention of cerebral hemorrhage, and renal function monitoring must be improved.

Use of Extracorporeal Membrane Oxygenation After Congenital Heart Disease Repair: A Systematic Review and Meta-Analysis

“…One hundred and three studies were excluded after full-text evaluation. Eventually, this systematic review was based on 43 studies, encompassing 38 case series ( 11 – 48 ) and 5 case-controlled studies ( 49 – 53 ). A flowchart depicting the search strategy is shown in the Figure 1 .…”

“…Bridging to heart transplant was reported in seven studies ( 12 , 13 , 27 , 31 , 34 , 35 , 53 ), while a subsequent ventricular assist device (VAD) implantation was only reported in one study ( 50 ). A total of 11 studies ( 12 , 14 , 16 , 23 , 24 , 26 , 36 , 38 , 44 , 45 , 48 ) reported the causes to in-hospital mortality, which was mainly caused by MODS, infections, and ventricular failure.…”

Short‐Term Mortality Among Pediatric Patients With Heart Diseases Undergoing Veno‐Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta‐Analysis

“…We further excluded 42 studies after full‐text evaluation, because they did not meet inclusion criteria. Eventually, 28 studies 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 were amenable to meta‐analysis (Figure 1 ).…”

“…In our meta‐analysis, applying a random‐effects model, the pooled short‐term mortality (28 studies,1736 patients) was 45.6% (95% CI, 38.7%–52.4%) (Figure 2 ). 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 There was no evidence for publication bias because of the funnel plot appearing visually symmetrical (Figure 3 ), and the Egger test suggesting insignificant difference for our primary outcome of interest ( P egger =0.23). The sensitivity analysis performed by excluding the studies with a Joanna Briggs Institute score <8, showed that the pooled short‐term mortality was 46.2% (95% CI, 39.0%–53.4%).…”

“…After excluding 5 studies that included a few patients with arrhythmias, cardiomyopathy, and others, we found a short‐term mortality of 48.9% (95% CI, 42.3%–55.6%) (Figure S1 ). 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 31 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 Removing studies reporting 30‐day mortality, the pooled mortality was 45.4% (95% CI, 37.9%–52.9%) (Figure S2 ). 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 The similar short‐term mortality ind...…”