Outcome of Cardiac ECMO in Children Less than 1 Year Age Undergoing Corrective Cardiac Surgery

Abstract

Extracorporeal membrane oxygenation (ECMO) has emerged as an effective mechanical support device to support both respiratory and cardiac function following cardiac surgery. The use of ECMO is more common among children who undergo complex surgical procedures. The objective of this study was to observe the outcomes of children subjected to central venoarterial (VA) ECMO after congenital cardiac surgery and identify the factors influencing survival in these children. Twenty children, below the age of 1 year, who underwent corrective cardiac surgery and were placed on ECMO support within first 48 hours of biventricular repair, from July 2018 to June 2019, were included in this study. ECMO was initiated either in the operating room (either preoperative decision or unable to come off cardiopulmonary bypass [CPB]) or in the intensive care unit (low-cardiac output syndrome). The maintenance and weaning from ECMO was done as per institute protocol. At the initiation of ECMO, the flows were maintained between 100 and 150 mL/kg/min. The flows were decreased if it was possible to maintain normal perfusion with lesser flows. Out of 20 children, 12 children were less than or equal to 2 months of age. The 30-day survival was 45% and all the children were alive at 4 months after discharge from hospital. A negative cumulative fluid balance (CFB) of more than 50 mL/kg in the first 48 hours, decreasing lactate and inotropic score, and improving ventricular function in the first 3 days of ECMO were associated with improved survival. The following factors were correlated with decreased survival: aortic cross-clamp time (AOCX T) more than 106 minutes, higher initial ECMO flows (75 vs. 52%), ECMO duration more than 4 days, increased transfusion of blood and blood products, urine output < 1.06 ± 0.81/kg/h (in the first 48 h), and increasing trend of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).