Structured review of post-cardiotomy extracorporeal membrane oxygenation: Part 2—pediatric patients
Journal
Journal of Heart and Lung Transplantation
Journal Volume
38
Journal Issue
11
Pages
1144-1161
Date Issued
2019
Author(s)
Lorusso R.
Raffa G.M.
Kowalewski M.
Alenizy K.
Sluijpers N.
Makhoul M.
Brodie D.
McMullan M.
Wang I.-W.
Meani P.
MacLaren G.
Dalton H.
Barbaro R.
Hou X.
Cavarocchi N.
et al.,
Abstract
Veno-arterial extracorporeal membrane oxygenation (ECMO) is established therapy for short-term circulatory support for children with life-treating cardiorespiratory dysfunction. In children with congenital heart disease (CHD), ECMO is commonly used to support patients with post-cardiotomy shock or complications including intractable arrhythmias, cardiac arrest, and acute respiratory failure. Cannulation configurations include central, when the right atrium and aorta are utilized in patients with recent sternotomy, or peripheral, when cannulation of the neck or femoral vessels are used in non-operative patients. ECMO can be used to support any form of cardiac disease, including univentricular palliated circulation. Although veno-arterial ECMO is commonly used to support children with CHD, veno-venous ECMO has been used in selected patients with hypoxemia or ventilatory failure in the presence of good cardiac function. ECMO use and outcomes in the CHD population are mainly informed by single-center studies and reports from collated registry data. Significant knowledge gaps remain, including optimal patient selection, timing of ECMO deployment, duration of support, anti-coagulation, complications, and the impact of these factors on short- and long-term outcomes. This report, therefore, aims to present a comprehensive overview of the available literature informing patient selection, ECMO management, and in-hospital and early post-discharge outcomes in pediatric patients treated with ECMO for post-cardiotomy cardiorespiratory failure. ? 2019 International Society for Heart and Lung Transplantation
Subjects
cardiac surgical procedures; child; congenital; extracorporeal membrane oxygenation; post-cardiotomy cardiogenic shock; post-cardiotomy circulatory assistance
SDGs
Other Subjects
Article; cannulation; cardiopulmonary insufficiency; cardiotomy; cardiovascular mortality; clinical education; decompression; extracorporeal oxygenation; health care cost; heart catheterization; heart single ventricle; heart surgery; heart transplantation; hospital discharge; human; medical ethics; patient selection; postoperative period; priority journal; respiratory failure; resuscitation; survival; treatment duration; treatment indication; treatment outcome; trend study; adverse event; child; congenital heart malformation; postoperative complication; procedures; Cardiac Surgical Procedures; Child; Extracorporeal Membrane Oxygenation; Heart Defects, Congenital; Humans; Postoperative Complications; Treatment Outcome
Type
journal article