Cardiopulmonary mechanical support in a Pediatric Heart Center

Abstract

Aim: A pooled analysis of the experience of a single center with the use of mechanical circulatory and ventilatory support pediatric patients in the treatment of circulatory and respiratory failure unresponsive to conservative therapy. Methods: A retrospective study of all pediatric patients treated by cardiopulmonary (CP) mechanical support in the Pediatric Heart Center of Prague-based Motol University Hospital, with emphasis on the risk factors affecting mortality in this patient population. Group of patients: Over the years 1991-2007, we performed CP mechanical support in 38 children aged 1 day-17.9 years (median 2.2 years) with a body weight of 2.2-73 kg (median 11.6 kg). Thirty-six of the 38 patients had congenital heart disease. Indications for initiating CP mechanical support included patient's intolerance of weaning from the extracorporeal circuit following cardiac surgery (early post-cardiotomy failure) in 19 patients (50%), circulatory arrest with subsequent CP resuscitation in 11 patients (29%), circulatory instability with a low cardiac output refractory to conventional therapy or postoperative chest opening following cardiac surgery (late post-cardiotomy failure) in 4 patients (10.5%), acute respiratory failure after cardiac surgery in 3 patients (8%), and heart failure unresponsive to conventional therapy in one patient (2.5%). Cardiopulmonary support using extracorporeal circuit membrane oxygenation (ECMO) was employed in 35 cases and left ventricular assist device (LVAD) using centrifugal pump was used in 3 children. Results: Nineteen of the 38 patients (50%) could be successfully weaned from mechanical support. The mean times of CP mechanical support were 16 and 40 hours with patients who survived and died, respectively. In the group of 19 (50%) deceased patients, there was a significantly higher incidence of renal failure requiring the institution of an elimination method in 12/19 patients (63%) and bleeding from the surgical wound and lungs in 11/19 patients (57%). Seventeen patients (45%) are currently alive over an intermediate follow-up period of 2 months-13.7 years (median, 3.1 years). Among 11 children connected to mechanical support during CP resuscitation, 6 (54%) are alive without a neurological deficit. Conclusion: Cardiopulmonary mechanical support was effective in the management of heart and lung failure refractory to conservative therapy in up to 50% of patients. This method is essential in comprehensive care of children with congenital heart disease.