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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2021; 69(S 03): e41-e47
DOI: 10.1055/s-0041-1730034
Pediatric and Congenital Cardiology

Postcardiotomy Extracorporeal Membrane Oxygenation in Neonates

Xindi Yu
1   Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
,
Yinyu Yang
1   Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
,
Wei Zhang
1   Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
,
Zheng Guo
1   Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
,
Jia Shen
1   Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
,
Zhuoming Xu
1   Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
,
Haibo Zhang
1   Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
,
Wei Wang
1   Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
› Author Affiliations
Funding Funded by National Natural Science Foundation of China (grant number 82070430).
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Abstract

Background Extracorporeal membrane oxygenation (ECMO) provides circulatory support in children with congenital heart disease, particularly in the setting of cardiopulmonary failure and inability to wean from cardiopulmonary bypass. This study summarized the clinical application of ECMO in the treatment of heart failure after cardiac surgery in neonates.

Materials and Methods Clinical data of 23 neonates who received ECMO support in our center from January 2017 to June 2019 were retrospectively analyzed.

Results Twenty-three neonates, aged from 0 to 25 days and weight between 2,300 and 4,500 g, with heart failure postcardiotomy were supported with ECMO. The successful weaning rate was 78.26% and discharge rate was 52.17%. Bleeding and residual malformation were the most common complications. The univariate analysis showed that nonsurvivors were related to the factors such as higher lactate value of ECMO 12 and 24 hours (p = 0.008 and 0.001, respectively), longer time to lactate normalization (p = 0.001), lactate > 10 mmol/L before ECMO (p = 0.01), lower weight (p = 0.01), longer ECMO duration (p = 0.005), lower platelet count (p = 0.001), more surgical site bleeding (p = 0.001), and surgical residual malformation (p = 0.04). Further logistic regression analysis revealed that higher lactate value of ECMO 24 hours (p = 0.003), longer ECMO duration (p = 0.015), and surgical site bleeding (p = 0.025) were independent risk factors.

Conclusion ECMO was an effective technology to support the neonates with cardiopulmonary failure after open heart surgery. Control the lactate acidosis and surgical site bleeding event may be helpful for patients' recovery.

Keywords

neonate - extracorporeal membrane oxygenation - congenital heart disease - open heart surgery

Authors' Contribution

Yu Xin-di designed the study and drafted the manuscript; Yang Yin-yu, Zhang Wei, Guo Zheng, Shen Jia, Zhuoming Xu, and Haibo Zhang performed data collection; Wang Wei helped perform data analysis. All authors read and approved the final manuscript.


Preprint Disclosure

A previous version of this manuscript was put on the Authorea preprint platform on September 16, 2020, for a different open review process with another journal. The manuscript itself was not formally published somewhere else.




Publication History

Received: 28 December 2020

Accepted: 07 April 2021

Article published online:
29 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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