Proposed Entry Criteria for Postoperative Cardiac Extracorporeal Membrane Oxygenation After Pediatric Open Heart Surgery

: While extracorporeal membrane oxygenation (ECMO) is being used increasingly after pediatric cardiac surgery, criteria are lacking for initiating ECMO after bypass weaning. To develop clinically useful ECMO entry criteria based on parameters readily available, children were examined at postoperativ...

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Bibliographic Details
Published in:Artificial organs 1999-11, Vol.23 (11), p.1010-1014
Main Authors: Trittenwein, Gerhard, Pansi, Heike, Graf, Bernadette, Golej, Johann, Burda, Gudrun, Hermon, Michael, Marx, Manfred, Wollenek, Gregor, Trittenwein, Hildegard, Pollak, Arnold
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Factors
Analysis of Variance
Blood Pressure
Body Weight
Cardiac Output, Low - etiology
Cardiac Output, Low - therapy
Cardiac Surgical Procedures
Central venous oxygen saturation
Child
Child, Preschool
Congenital heart disease
Critical Care
Extracorporeal Membrane Oxygenation
Extracorporeal membrane oxygenation entry criteria
Forecasting
Heart Defects, Congenital - diagnosis
Heart Defects, Congenital - surgery
Hospital Mortality
Humans
Infant
Lactate
Lactates - blood
Logistic Models
Odds Ratio
Outcome Assessment (Health Care)
Oxygen - blood
Patient Admission
Patient Selection
Postoperative Care
Postoperative extracorporeal membrane oxygenation
Retrospective Studies
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Summary:: While extracorporeal membrane oxygenation (ECMO) is being used increasingly after pediatric cardiac surgery, criteria are lacking for initiating ECMO after bypass weaning. To develop clinically useful ECMO entry criteria based on parameters readily available, children were examined at postoperative pediatric intensive care unit (PICU) admission. Using hospital mortality as the primary outcome, univariate and multiple logistic regressions were performed to estimate the predictive value of clinical (age, weight, and diagnosis) and laboratory (arterial blood pressure, pH, lactate, creatine kinase, and arterial and central venous oxygen saturation [ScvO2]) variables. Data from 218 children over a 2 year period were analyzed retrospectively. Univariate regression demonstrated that age, weight, diagnosis, blood pressure, venous and arterial saturation, and lactate were significantly associated with postoperative mortality (p < 0.05). In multiple regression, ScvO2 and lactate level were found to be independent predictors and were used in a predictive model (ScvO2 odds ratio: 2.03–828.6, p = 0.016) (lactate odds ratio: 1.58 –4.20, p = 0.0002) (R2 = 0.70). Applying an 80% risk of mortality to establish entry criteria as in neonatal ECMO, PICU admission values of lactate > 70mg/dl if ScvO2 < 60% or lactate >163mg/dl if ScvO2 > 60% are proposed to serve as postoperative ECMO entry criteria if bypass weaning has been possible but is followed by low cardiac output.
ISSN:0160-564X
1525-1594
DOI:10.1046/j.1525-1594.1999.06457.x