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Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2010 Aug; Vol. 140 (2), pp. 330-336.e2. - Publication Year :
- 2010
-
Abstract
- Objective: Our objective was to assess the morbidity and mortality in children requiring extracorporeal membrane oxygenator support after cardiac surgery and to determine factors influencing outcome.<br />Methods: Between January 2003 and June 2008, 58 patients required extracorporeal membrane oxygenator support after cardiac surgery. A retrospective study was performed and factors influencing outcome were determined by logistic regression modeling with the probability of outcome based on a combination of multivariate predictors.<br />Results: Median age and weight were 12 days and 3.3 kg, respectively. Thirty-one patients had single ventricle repair and 27 had biventricular repair. Median duration of support with the oxygenator was 6 days. Thirty-nine (67%) patients were successfully weaned off the support, but only 24 (41%) survived to hospital discharge. Chief complications were renal failure (31%), neurologic complications (29%), and sepsis (16%). Multivariable logistic regression analysis identified 10 days or more of extracorporeal membrane oxygenation (odds ratio = 6.1), urine output less than 2 mL x kg(-1) x h(-1) in first 24 hours (odds ratio = 15), renal failure (odds ratio = 9.4), and pH less than 7.35 after 24 hours of extracorporeal membrane oxygenation (odds ratio = 82) as significant independent factors associated with failure to wean off extracorporeal membrane oxygenation. Factors associated with failure of hospital discharge despite successful decannulation were as follows: extracorporeal membrane oxygenator support time of 10 days or more, red blood cell transfusion of greater than 1000 mL/kg during the entire period of oxygenator support, and sepsis. Patients with single ventricle repair were at higher risk of hospital mortality.<br />Conclusion: Longer duration of extracorporeal membrane oxygenator support, low pH and urine output in the first 24 hours, and renal failure are significant factors associated with mortality during extracorporeal membrane oxygenator support. Exposure to high amounts of blood transfusion during extracorporeal oxygenation, extended extracorporeal membrane oxygenator support, and sepsis increase risk of death after successful decannulation.<br /> (Copyright 2010. Published by Mosby, Inc.)
- Subjects :
- Blood Transfusion mortality
Female
Heart Defects, Congenital mortality
Heart Defects, Congenital physiopathology
Hospital Mortality
Humans
Hydrogen-Ion Concentration
Infant
Infant, Newborn
Kaplan-Meier Estimate
Logistic Models
Male
Odds Ratio
Patient Discharge
Postoperative Care
Renal Insufficiency etiology
Renal Insufficiency mortality
Retrospective Studies
Risk Assessment
Risk Factors
Sepsis etiology
Sepsis mortality
Time Factors
Treatment Outcome
Urination
Cardiac Surgical Procedures adverse effects
Cardiac Surgical Procedures mortality
Extracorporeal Membrane Oxygenation adverse effects
Extracorporeal Membrane Oxygenation mortality
Heart Defects, Congenital surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 140
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 20637917
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2010.02.034