Outcome of children after a second support of Extracorporeal membrane Oxygenation (ECMO)
CCCF ePoster library. Dekate P. Oct 26, 2015; 114759; P2
Parag Dekate
Parag Dekate
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Abstract
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P2


Topic: Retrospective or Prospective Cohort Study


Outcome of children after a second support of Extracorporeal membrane Oxygenation (ECMO)



Parag Dekate, T. Humpl, N. Singhal, p. dekate, O. Honjo, A. Guerguerian

Critical care Medicine, The Hospital for Sick Children, Toronto, Canada | Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada | Critical Care Medicine, The Hopsital for Sick Children, Toronto, Canada | Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada | Criitical care Medicine, The Hospital for Sick Children, Toronto, Canada | Critical care Medicine, The Hospital for Sick Children, Toronto, Canada

Introduction: The use of mechanical circulatory support has increased over recent years. Extracorporeal membrane oxygenation (ECMO) plays an important role in pediatric critical care medicine as a short term management for children with cardio-respiratory failure. Simultaneously children getting exposed to ECMO more than once and may be associated with higher mortality and morbidity. We analyzed our institutional experience with multiple ECMO support.

Objectives:

1. Quantify patient population requiring more than one interval of ECMO support.
2. Delineating underlying diagnosis.
3. Assess outcome of children undergoing multiple ECMO support



Methods:

1. Patients undergoing two or more times support with ECMO fromFebruary 1995 to August 2014 were identified using hospital electronic databases
2. Retrospective review of included patient demographics,diagnosis, surgical procedure, ECMO duration, indications, organ dysfunction,and requirement of renal replacement therapy were collected and expressed asmean, mode, median and SD or qualitatively when appropriate.
3. Tomeet criteria for 2 separate intervals of ECMO a period of ≥6 hours without ECMO support was necessarybetween 2 runs of ECMO



Results: A total of 47 patients 2 were supported twice and 4 were supported three times with ECMO. Out of 47, 22 were male and 25 were female, 40/47 had congenital heart disease (CHD) while 5 had cardiomyopathy and 2 had primary pulmonary hypertension with normal structural heart. Average age of patients (age ≤90 days) at first run (23/47) was 28.3 days and at second run (13/47 ) was 45.4 days, while 24/47 and 34/47 patients had age ≥91 days with average age of 5.4 years and 4.7 years respectively. Common CHD were hypoplastic left heart syndrome (14/47) and atrioventricular septal defects (7/47). 36 of 47 and 26 of 47 patients had immediate preceding corrective surgery before first and second run of ECMO respectively. Common causes of ECMO support were cardiac arrest, low cardiac output state and unable to wean from cardiopulmonary bypass. Most of the patients were in the critical care unit before initiation of ECMO and all patients from the ward and cardiac catheterization laboratory required extracorporeal-cardiopulmonary resuscitation (E-CPR). The most common mode of initiation for first run of ECMO was E-CPR (27/47) with mean duration of E-CPR (from continuing CPR and starting ECMO) 28±11.8min and for second run of ECMO was elective 28/47. 19/47 underwent E-CPR during second run with mean duration of E-CPR 36.5±14.9min. Open sternum cannulation is most common in both (31/47 Vs 24/47) followed by neck cannulation (12/47 Vs 18/47). Mean duration of first and second run of ECMO was 110±98.6 and 133.1±113.7 hours respectively. During both run of ECMO renal dysfunction was evident in (32/47 Vs 35/47), liver dysfunction (22/47 Vs 25/47), both liver and renal dysfunction was present in 20/47 Vs 20/47. More than half patients had at least one intervention (chest exploration, diagnostic or interventional heart catheterization or corrective surgery) while on ECMO (first-26/47 Vs second-25/47). At the end of second and or third support of ECMO 10 survived, the most common cause of death is withdrawal of life sustaining therapy due to poor prognosis. Average duration of follow up for these survived patients is 0.4-17 years. Out of them 3 had no disability with independent living, 4 had mild disability with independent existence, 1 had moderate to severe disability, and 2 had severe disability.

Conclusion: ECMO remains an important supportive mode of management. Multiple supports with ECMO is feasible, however, we detected a high rate of mortality and morbidity

References:
1. Outcomes of second-run extracorporeal life support in children: a single-institution experience. Bohuta L et al. Ann Thorac Surg. 2011 Sep;92(3):993-6
2. Survival of children requiring repeat extracorporeal membrane oxygenation after congenital heart surgery. Shuhaiber J et al. Ann Thorac Surg. 2011 Jun;91(6):1949-55
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