Miki Asano
Nagoya City East Medical Center, Japan
Title: Pediatric extracorporeal membrane oxygenation after cardiac surgery and analysis of early and long term outcomes
Biography
Biography: Miki Asano
Abstract
Background: We evaluate the morbidity and mortality in pediatric post cardiotomy extracorporeal membrane oxygenation to determine independent factors affecting outcomes.
Methods: Between January 2002 and December 2017. 82 extracorporeal membrane oxygenation after cardiac surgery in 76 children were reviewed retrospectively. Follow-up was completed in December 2018. Logistics regression analysis and Cox proportional hazard model was used for the predictive risk analysis.
Results: Age and weight were 14.0±25.3 months and 6.6±5.1 kg respectively. Median support time was 8.3±4.5 days.
Sixty nine (84%) were successfully weaned off ECMO and 50 (61%) survived to hospital discharge. Multivariate logistic regression analysis distinguished the first day to obtain negative fluid balance after initiation of support (adjusted odds ratio=0.43), the highest lactate (0.95) and bilirubin (0.83) during support as significant independent factors associated with successful separation from extracorporeal membrane oxygenation. The day of first negative fluid balance (0.64) after successful decannulation was independent risk factors on survival to the hospital discharge.
Actuarial 1 year, 5 year and 10 year survival rate after hospital discharge was 94%, 82% and 81%, respectively. Impact factors affecting multivariable Cox hazard model indicated weight had impact on survival after hospital discharge.
Conclusions: Higher serum lactate/bilirubin, unable to obtain earlier negative fluid balance during the support had impact on mortality of decannulation. Later obtaining negative fluid balance and continuation of peritoneal dialysis in post-extracorporeal membrane oxygenation increased independent risk of death after successful weaning.