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Outcomes following venoarterial extracorporeal membrane oxygenation in children with refractory cardiogenic disease

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Abstract

Retrospective analysis was performed at an affiliated university children’s hospital with consecutive patients receiving a venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock from July 2007 to May 2018. Fifty-six patients underwent VA-ECMO for refractory cardiogenic shock with the median age of 39.0 (1.5, 103.5) months were included. Median ECMO duration was 87 h, and the median length of hospital stay was 22 days. Successful ECMO weaning rate was 68%. Thirty-day mortality in this cohort was 39% (22/56), among which the mortality of fulminant myocarditis and postcardiotomy cardiogenic shock (PCS) were 23% (6/26) and 52% (12/23), respectively. Multivariate Cox proportional hazard regression analysis identified prolonged prothrombin time (PT) > 6 s and elevated lactate level 24 h after ECMO initiation were associated with 30-day mortality.

Conclusions: Pediatric VA-ECMO for refractory cardiogenic shock appears to be a satisfactory salvage therapy to various fatal diseases in this retrospective study. Prolonged PT > 6 s and elevated lactate level 24 h were significant predictors of 30-day mortality.

What is Known:

• VA-ECMO is a salvage therapy for refractory cardiogenic shock in pediatrics.

What is New:

• Prothrombin time > 6 s was a significant predictor of 30-day mortality.

• Elevated lactate level 24 h was a significant predictor of 30-day mortality

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Abbreviations

ACT:

Activated clotting time

AFM:

Acute fulminant myocarditis

ALT:

Alanine transaminase

AST:

Aspartate transaminase

DIC:

Disseminated intravascular coagulation

ECLS:

Extracorporeal life support

ECPR:

Extracorporeal cardiopulmonary resuscitation

GI:

Gastrointestinal

ICU:

Intensive care unit

PCS:

Postcardiotomy cardiogenic shock

PT:

Prothrombin time

RCS:

Refractory cardiogenic shock

VA-ECMO:

Venoarterial extracorporeal membrane oxygenation

VIS:

Vasoactive-inotropic score

TGA:

Transposition of the great arteries

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Acknowledgements

Our deepest gratitude goes first and foremost to Professor Ru Lin, for her constant encouragement and guidance. Second, we would like to express our thanks to our colleagues who have contributed to this article.

Funding

This study has been funded by the Science and Technology Planning Project of Zhejiang Province, China (LGF18H020005).

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Authors and Affiliations

  1. Department of Extracorporeal Circulation and Extracorporeal Life Support, Heart Institute, Zhejiang University School of Medicine Children’s Hospital, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, Zhejiang, China

    Lijun Yang, Lifen Ye, Yong Fan, Wenlong He, Qing Zong, Wenting Zhao & Ru Lin

Authors
  1. Lijun Yang
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  2. Lifen Ye
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  3. Yong Fan
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  4. Wenlong He
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  6. Wenting Zhao
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  7. Ru Lin
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Contributions

Project idea by Lijun Yang and Ru Lin; data collection by Wenlong He, Qing Zong, and Wenting Zhao; Yong Fan and Lifen Ye helped to review the manuscript, which was approved by all authors.

Corresponding author

Correspondence to Ru Lin.

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The authors declare that they have no conflict of interest.

Ethical approval

Zhejiang University School of Medicine Children’s Hospital Committee on Clinical Investigation approved the review of patient medical records. This article does not contain any studies with human participants or animals performed by any of the authors.

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For this type of study, formal consent is not required.

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Communicated by Peter de Winter

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Yang, L., Ye, L., Fan, Y. et al. Outcomes following venoarterial extracorporeal membrane oxygenation in children with refractory cardiogenic disease. Eur J Pediatr 178, 783–793 (2019). https://doi.org/10.1007/s00431-019-03352-5

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  • DOI: https://doi.org/10.1007/s00431-019-03352-5

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