体外膜式氧合的临床应用

目的总结体外膜式氧合（ECMO）在临床的应用经验,以提高对危重患者的治疗效果。方法2006年7月至2008年2月,27例患者使用ECMO,其中非手术急性心肺功能衰竭8例,心脏手术后的心功能辅助4例,心脏不停跳冠状动脉旁路移植术中心脏功能辅助13例,体外循环与ECMO相互转换应用于心脏手术中和术后的心功能辅助2例。结果27例患者应用ECMO辅助时间为2～61h,26例成功撤离ECMO,1例82岁患者成功撤离ECMO后24h出现轻度二氧化碳潴留,患者家属要求出院;2例院内死亡;24例康复出院。结论ECMO是抢救心肺功能衰竭的有效方法,对非手术患者或高危患者行心脏不停跳冠状动脉旁路移植术以及心脏手术中、手术后的心脏功能辅助亦有明显的效果。     

体外膜肺氧合用于困难气道的研究进展

体外膜肺氧合(ECMO)是一套体外循环系统,通过对患者引出的血液进行体外氧合后回输,可以有效代替患者的心肺功能。作为一种辅助手段,ECMO常用于重症心肺功能衰竭患者的急救以及心肺手术的体外循环。而对于合并困难气道的患者,在常规氧合方法无法提供有效氧合的情况下,ECMO可以满足氧合需求。鉴于ECMO的诸多优势,建议将其纳入气道管理指南。本文就近年来ECMO用于困难气道患者的研究进展做一综述。     

单肺通气时吸入不同浓度氧对围术期氧合的影响

目的探讨食管癌患者术中单肺通气(OLV)时吸入不同浓度氧(FiO2)对围术期氧合的影响。方法选择拟行左侧剖胸食管癌根治术患者90例,随机均分为三组,每组30例,分别在OLV时将FiO2设定为60%(L组)、75%(M组)和90%(C组)。分别在麻醉前(T0)、OLV前(T1)、OLV 30min(T2)、60min(T3)、120min(T4)及恢复双肺通气(TLV)后30min(T5)、术后24h(T6)抽取动脉血测PaO2、SaO2、pH、PaCO2,计算氧合指数(PaO2/FiO2),同时持续监测SpO2、PETCO2、气道峰压(Ppeak)、气道平台压(Pplat)和气道顺应性(Cldyn)。结果 L组、M组、C组分别有6例、1例、1例患者在OLV 1h内SpO2下降到95%以下,被剔除出组。T2~T4时L组PaO2明显低于M、C组,M组明显低于C组(P0.05);T2~T4时L组SaO2、SpO2明显低于M、C组(P0.05)。三组各时点PaO2/FiO2、pH、PaCO2、PETCO2差异无统计学意义。结论左侧剖胸行食管癌根治术患者术中OLV时FiO2降低到75%时循环稳定,氧合充分。     

体外膜式氧合在大动脉转位术后心室功能恢复与训练中的应用

目的评价体外膜式氧合(extracorporeal membrane oxygenation,ECMO)支持在婴幼儿大动脉错位(TGA)患者大动脉转位术(ASO)后心室功能恢复和适应性训练的临床结果及可行性。方法 2005年1月至2008年8月,北京阜外心血管病医院7例TGA患者接受ASO后需要ECMO支持,其中男3例,女4例;年龄3周~14个月。ASO后心室不能适应新的血流动力学和/或合并心功能受损,采用静脉-动脉-ECMO辅助,占同期小儿先天性心脏病患者术后应用ECMO的36.84%(7/19)。插管途径为经胸右心房引流,升主动脉灌注;采用ECMO系统为:Biomedicu(Medtronic)4例,Jostra 2例,Medos 1例;辅助流量20~100 ml/kg。结果 7例患者平均转流时间174h(64~266 h),心室训练时间平均96 h。4例成功脱离ECMO,脱机率57.14%(4/7);3例出院。死亡4例,其中3例不能脱离ECMO直接死亡,死亡原因为肾功能衰竭1例,出血1例,多器官功能衰竭1例;1例在脱离ECMO后6 d感染死亡。结论 ECMO能为TGA患者ASO后心功能的恢复和左心室适应性训练提供有效的支持。     

体外膜氧合机械辅助在心脏移植手术中的应用

目的回顾性研究接受心脏移植手术并采用体外膜氧合(ECMO)辅助支持治疗的患者,总结临床经验,为进一步推广提供参考。方法收集中国医学科学院阜外心血管病医院接受心脏移植手术并采用ECMO支持受者的临床资料,分析受者围手术期ECMO应用情况,统计ECMO支持时间,合并使用主动脉内球囊反搏(IABP)的情况,并发症发生情况等临床资料。采用SPSS23.0软件处理,正态分布采用独立样本Student's test,非正态分布采用非参数检验Mann-Whitney U test。分类资料的组间比较采用χ2检验或Fisher确切检验法。结果所有ECMO支持模式均为静脉-动脉ECMO模式(V-A ECMO)。有8例受者成功使用ECMO过渡到心脏移植。使用ECMO的心脏移植受者中61例(89.7%)成功脱离ECMO机械辅助,48例(70.5%)存活出院。出血、术后急性肾功能不全、肺部感染等并发症是心脏移植ECMO循环支持过程中最多见的并发症。在手术室早期建立ECMO辅助循环的心脏移植受者脱机率和存活率分别为95.6%和84.4%,而在ICU床旁建立ECMO的受者脱机率和存活率分别为72.2%和27.8%,早期使用ECMO结果更好。结论ECMO机械辅助循环能对心脏移植受者提供有效的循环、呼吸功能支持,使得受者平稳渡过移植手术围术期。提倡早期、同期联合应用IABP增加重要器官的灌注,改善受者的预后,获得良好的转归。     

体外膜式氧合治疗心脏术后急性心肺功能衰竭

目的 探讨体外膜式氧合(ECMO)治疗心脏术后急性心肺功能衰竭的经验.方法 回顾性分析2005年3月至2008年6月心脏术后接受ECMO辅助的117例患者的临床资料.男性85例,女性32例,平均年龄(48.7±16.5)岁.其中80例患者因术中无法脱离心肺转流、35例因术后急性心脏功能衰竭进行静脉-动脉转流,2例因术后急性呼吸功能衰竭进行静脉-静脉转流.结果 平均ECMO辅助时间61 h,平均监护室停留时间5 d.87例(74.4%)成功脱离ECMO,69例(59.0%)痊愈.主要并发症为出血38例、感染32例、肾功能衰竭需要透析29例、氧合器血浆渗漏29例、溶血7例、肢体血栓5例、神经系统并发症4例.结论 ECMO是一种有效的短期机械辅助方法,应掌握适应证尽早建立,积极防治并发症可降低死亡率.     

边缘性供心移植术中采用体外膜肺氧合技术四例

目的 研究体外膜肺氧合(ECMO)技术用于边缘性供心移植的临床效果.方法 4例患者心脏移植时采用ECMO技术,其供心的冷缺血时间长达4.8～8.0 h.术中采用ECMO技术代替体外循环,全流量控制在4.5～5.0 L/min,术后流量降到1/2左右时,改为经典的ECMO心脏辅助管路的连接方式,带ECMO辅助回到重症监护室,随后在合适的时机撤除ECMO的辅助.结果 4例手术均顺利完成,主动脉开放后心脏自动复跳.术中阻断时间为(90±3)min,转机(136±14)min,转流时的主动脉流量为50～70 ml·kg-1·min-1,氧流量为2～4 L/min.4例患者均于术后第2天撤除ECMO,术后ECMO辅助时间为(16±4)h.2例术后出现出血,1例右下肢出现淋巴漏和神经过敏,经过积极治疗后好转,无右心衰竭和三尖瓣明显返流现象.4例患者恢复顺利,出院时左心室舒张末径为37～43 mm,左心室射血分数为56 %～64 %,三尖瓣无返流或仅有轻度返流,心功能均为Ⅱ级.结论 以ECMO代替体外循环技术可以有效地保护供心,有利于经历长时间缺血的供心恢复功能.     

体外膜肺氧合支持治疗在成人终末期心脏病中的临床应用

目的总结10例成人终末期心脏病患者应用体外膜肺氧合(ECMO)支持治疗的临床经验。方法自2005年7月至2006年6月,对10例成人终末期心脏病患者行ECMO支持治疗,其中终末期心肌病6例,冠心病3例,心脏移植术后1例。所有患者在ECMO支持治疗前都伴有难以控制的心源性休克和/或急性呼吸衰竭。所有患者均采用股动-静脉插管行ECMO支持治疗。ECMO期间镇静或清醒,维持血流动力学和血气指标稳定。结果ECMO辅助支持时间54~416h,平均139h。8例患者顺利脱离ECMO,其中6例生存,2例死亡;2例患者不能脱机,放弃治疗,均死亡。6例患者随访1年,均生存。结论ECMO可对成人终末期心脏病合并急性心肺功能衰竭患者提供有效的支持治疗,为心脏移植或心功能的恢复赢得时间,延长部分高危患者的生命。     

体外膜式氧合相关并发症分析

目的 分析体外膜式氧合(ECMO)辅助过程中相关并发症情况,以期对提高ECMO辅助抢救成功率.方法 回顾2005年3月至2008年6月117例接受ECMO辅助者的临床资料,其中静脉-静脉转流2例,静脉-升主动脉转流5例,股静脉-股动脉转流110例.结果 ECMO平均辅助时间61h.死亡48例,病死率41.0%.74例治疗过程中发生各种并发症,发生率为63.2%.主要并发症为感染32例次、肾功能衰竭需要透析29例次、氧合器血浆渗漏29例次、二次开胸止血24例次潲化道出血14例次、溶血7例次、肢体血栓5例次、神经系统并发症4例次、离心泵故障1例次.结论 出血是ECMO早期最常见的并发症,随辅助时间延长,感染、肾功能衰竭及氧合器血浆渗漏等并发症明显增加.积极预防、治疗并发症对提高ECMO病人抢救成功率非常重要.     

体外膜肺氧合辅助后高胆红素血症的临床意义

目的 探讨体外膜肺氧合(ECMO)辅助病人高胆红素血症的发病率及其对住院死亡的影响.方法 收集2005年至2008年65例应用ECMO辅助的成年病人资料,记录血流动力学、血牛化指标等以及临床转归.结果 51例成功脱离ECMO,脱机率为78.5%,33例生存出院,总病死率49.2%.55.4%的ECMO辅助病人发生高胆红素血症,其病死率明显高于非高胆红素血症组(P<0.01).Logis-tic回归分析显示,高胆红素血症明显增加病人住院死亡风险(OR=3.895,P<0.01).结论 高胆红素血症在ECMO辅助病人中的发病率较高,是增加术后病死率的影响因素之一,应及时处理,以改善病人的临床转归.     

Ventricular function determination during extracorporeal membrane oxygenation (ECMO) following Norwood operation: a case report

Extracorporeal membrane oxygenation has been used successfully to support both cardiac and pulmonary function following Stage I Norwood operation. Determination of the return of native cardiac function and pulmonary function can be easily accomplished because of the single ventricle physiology. The pulmonary function can be assessed while on full flow ECMO by isolating the membrane oxygenator gas compartment, allowing evaluation of native pulmonary gas exchange through the modified Blalock-Taussig shunt. Cardiac output can be calculated by using the following oxygen delivery equation: Total O2 delivery = ECMO oxygen delivery + ventricular oxygen delivery. The ventricular O2 saturation used in the formula for oxygen delivery is same as the mixed venous O2 saturation returning to the ECMO pump because of the large atrial communication following the Norwood operation. A 3.2 kilogram patient was placed on a pediatric ECMO circuit utilizing a heparin-coated centrifugal pump and a microporous membrane oxygenate after failure to wean from bypass because of a low oxygen saturation and poor ventricular function. On day 1 of support, the systemic arterial oxygen saturation was 100% and matched the ECMO arterial saturation. On day 2 of the support, the patient's arterial saturation decreased to 96%, and the ECMO mixed venous saturation was 87%. Using the oxygen delivery formula, the ventricular cardiac output was calculated to be 175 mL/min, with an ECMO flow of 400 mL/min for a total cardiac output of 575 mL/min. The native ventricular contribution was, therefore, 30% of total cardiac output. Calculation of cardiac output would normally require a left ventricular sample in a patient with biventricular physiology. The single ventricle physiology in the post-operative Norwood patient makes this calculation a useful tool for assessing return of ventricular function in these patients.     

The effect of left-to-right shunting on coronary oxygenation during extracorporeal membrane oxygenation.

BACKGROUND/PURPOSE: Blood perfusion to the coronary artery (CA) during venoarterial (VA) extracorporeal membrane oxygenation (ECMO) was examined to determine whether it was receiving highly oxygenated ECMO blood or desaturated blood from the pulmonary circulation of diseased lungs. METHODS: In the first experiment, left ventricle output and oxygen saturation in the left ventricle (LV) and CA were measured in dogs placed on VA ECMO. In the second experiment, dogs with an artificial subclavian-pulmonary artery shunt were placed on VA ECMO at 100 mL/kg/min, and oxygen saturation was measured as the shunt flow increased. RESULTS: Without an artificial shunt, a substantial portion of coronary perfusion was found to be supplied by the left ventricle (54 + 30%), even at a high ECMO flow rate of 100 mL/kg/min and low LV output (22+/-17%) relative to ECMO flow. With a shunt, oxygen saturation in the CA was more than 95%, even when shunt flow was only 7.5% of ECMO flow and output from the left ventricle was less than 25% of the ECMO flow rate. CONCLUSIONS: These results suggest that an excessive "lung rest" strategy during VA ECMO may produce suboptimal coronary oxygenation possibly leading to myocardial damage. The presence of a small left-to-right shunt may prevent coronary hypoxia.     

Bacterial and Fungal Infection in Neonates Undergoing Venoarterial Extracorporeal Membrane Oxygenation: An Analysis of the Registry Data of the Extracorporeal Life Support Organization

Abstract: A review and analysis of 5,001 neonatal venoarterial (VA) extracorporeal membrane oxygenation (ECMO) cases showed that bacterial and fungal infection occurred in 147 (2.9%) and 26 (0.6%) patients, respectively, with an overall incidence of 3.5%. Bivariate analysis was used to compare infected infants with controls, bacterial versus fungal groups, and bacterial subgroups with respect to patient demographics, primary diagnosis, mechanical complications, patient complications, duration of the ECMO course, and hospital mortality. Logistic regression models were constructed using variables that were statistically significant from the bivariate comparisons. Variables that remained significant after multivariate analysis included primary diagnosis of pneumonia/ sepsis, mechanical complications of oxygenator failure, rupture of raceway or tubing, clots, and patient complications of hypertension and hyperbilirubinemia. The infection group had significantly longer mean total hours on bypass and higher hospital mortality. Infants with fungal infection had a significantly higher hospital mortality rate compared with those with bacterial infection. We conclude that infection during ECMO, especially fungal infection, carries an increased risk of hospital mortality and that mechanical complications are associated with an increased risk of infection.     

The influence of ductal left-to-right shunting during extracorporeal membrane oxygenation

Background/Purpose: The aim of this study was to analyze whether a ductal left-to-right (L-R) shunt will prolong extracorporeal membrane oxygenation (ECMO) in neonates with severe pulmonary hypertension. This report discusses the onset and termination of a ductal L-R shunt and its potential influences on ECMO when pulmonary hypertension decreases during venoarterial bypass. Methods: Twenty-nine neonates were monitored during veno-arterial ECMO, using bedside echocardiography with 12-hour interval observations. Results: Up to 43% of the patients showed this type of shunt already after 12 hours on bypass. In total, this type of ductal shunt was found between 12 and 72 hours on ECMO in 62% of the patients. After 72 hours, the ductal L-R shunt no longer was detected. In 38% of the patients, no ductal L-R shunt was found during ECMO. Comparisons between these 2 patient groups showed a significantly longer ECMO duration in patients with ductal L-R shunt (P [lt ] .007). The mean prolongation time was 46 hours. Also, a significant decrease of left atrium to aorta ratio (P [lt ] .01) was observed during ECMO in the ductus group after closure of the duct, illustrating the decrease in volume load for the left heart and lungs. Conclusions: Ductal L-R shunting is related with a substantial prolongation of the ECMO course (mean prolongation of almost 2 days). The authors suggest that on one side, the ductal L-R shunt will lead to pulmonary hypercirculation and on the other side, postductal stealing from the descending aortic circulation will lead to prerenal failure. Possibly because of interactions with pulmonary and renal function, a ductal L-R shunt will, among other factors, interfere with weaning from ECMO, resulting in a prolonged bypass time. J Pediatr Surg 37:1165-1168.     

Preclinical evaluation of a new hollow fiber silicone membrane oxygenator for pediatric cardiopulmonary bypass: ex-vivo study.

Based on the results of many experimental models, a hollow fiber silicone membrane oxygenator applicable for long-term extracorporeal membrane oxygenation (ECMO) was developed. For further high performance and antithrombogenicity, this preclinical model was modified, and a new improved oxygenator was successfully developed. In addition to ECMO application, the superior biocompatibility of silicone must be advantageous for pediatric cardiopulmonary bypass (CPB). An ex vivo short-term durability test for pediatric CPB was performed using a healthy miniature calf for six hours. Venous blood was drained from the left jugular vein of a calf, passed through the oxygenator and infused into the left carotid artery using a Gyro C1E3 centrifugal pump. For six hours, the O2 and CO2 gas transfer rates were maintained around 90 and 80 ml/min at a blood flow rate of 2 L/min and V/Q=3, respectively. The plasma free hemoglobin was maintained around 5 mg/dl. These data suggest that this newly improved oxygenator has superior efficiency, less blood trauma, and may be suitable for not only long-term ECMO but also pediatric CPB usage.     

Extended support with the Terumo Baby-RX oxygenator

The Terumo Baby-RX, a new-generation low prime oxygenator, recently has entered the perfusion market in North America. This oxygenator is designed exclusively for neonates and infants and has the smallest priming volume of any clinically available oxygenator. The BABY-RX also is treated with X Coating, Terumo's biocompatible, hydrophilic polymer surface coating that reduces platelet adhesion and protein denaturation. The oxygenator has a blood flow range of 0.1 to 1500 mL/min and operates with a minimum reservoir volume of 15 mL. A 3.2-kg patient, status post-Stage 1 Norwood, Palliation was placed on cardiopulmonary support after thrombus formation within the modified Blalock-Taussig shunt during a general surgery procedure. The extended support circuit incorporated the Baby-RX oxygenator for 17.5 hours. The oxygenator performed well over this time period at flows of 600-800 mL/min, sweep rates of 100-300 mL/min, FiO2 of 30-40%, and ACTs of 140-200 seconds. There were no indices of oxygenator failure noted within the time frame of support. After placement of a new systemic to pulmonary shunt, the patient was removed from support and the oxygenator drained of residual blood. No evidence of fiber damage or clot formation was noted. The patient had a successful support run without complications related to cardiopulmonary support.     

Extracorporeal membrane oxygenator support for human lung transplantation.

Extracorporeal membrane oxygenator (ECMO) support was provided for a 19-year-old boy undergoing right lung transplantation. Perfusion was begun several hours prior to transplant, to correct profound hypercapnia. After the operation, ECMO was required because of inadequate gas exchange by the transplanted lung. Perfusion was continued for a total of 96 hours. During this time, the temporary malfunction of the transplanted lung owing to the reimplantation response reversed, and the patient was successfully removed from the oxygenator and subsequently weaned from the ventilator. He died on the eighteenth postoperative day of bronchial dehiscence. ECMO support appears to be a feasible means of supporting patients during lung transplantation and during the period of reversible lung malfunction that may occur in the early postoperative period.     

Use of the CDI blood parameter monitoring system 500 for continuous blood gas measurement during extracorporeal membrane oxygenation simulation

The Oximetrix III Opticath (Abbott Critical Care Systems) is used for continuous measurement of venous saturation in a variety of applications, including extracorporeal membrane oxygenation (ECMO), despite clinical reports that have presented data showing poor accuracy of these devices. The CDI Blood Parameter Monitoring System 500 (Terumo) is an inline blood gas monitoring tool commonly used during cardiopulmonary bypass procedures to continuously assess oxygen saturation, blood gases, potassium, and bicarbonate. The purpose of this experiment was to compare the Opticath and the CDI 500 in trending venous blood saturation during a simulation of ECMO. An ECMO simulation circuit consisting of a silicone rubber membrane oxygenator and a stainless steel heat exchanger was constructed, and a standard venous reservoir bag was used to represent the patient. The CDI and the Opticath were incorporated side by side into a shunt that originated just before the oxygenator and returned flow to the venous line. The circuit was primed with fresh porcine blood and conditioned with the addition of CO2 to simulate typical venous blood under ECMO conditions. After an initial calibration procedure, samples were drawn and analyzed by an AVL Opti CCA (Roche/Osmetech) every 4-8 hours for a period of 7 days, with calibration of each device at sample intervals. The data were plotted, and a least squares regression line was calculated. The average error for venous saturation of the CDI and Opticath after 72 hours was 3.86 and 9.51 respectively. At 168 hours, error for the CDI was 8.37, and the Opticath had an error of 14.78. A correlation analysis of the CDI and AVL CCA analyzer yielded a correlation coefficient of r = .88 at 72 hours and r = .84 at 168 hours. Correlation between the Opticath and the AVL CCA yielded a correlation coefficient of r = .77 at 72 hours and r = .55 at 168 hours. Based on these findings, the CDI 500 is an effective tool for monitoring venous blood saturation under simulated conditions of ECMO. Keywords: CDI 500, Opticath, extracorporeal membrane oxygenation, venous saturation.     

Effects of ventilatory techniques during cardiopulmonary bypass on post-bypass and postoperative pulmonary compliance and shunt.

Pulmonary compliance and shunt were evaluated preoperatively, 30 minutes after cardiopulmonary bypass, and two hours postoperatively in 132 calves undergoing open-heart surgery with halothane and oxygen anesthesia. The calves were divided into 11 groups with respect to maintenance of the lungs during bypass. In Group 1 the lungs were collapsed during bypass. In all other groups the lungs were mechanically ventilated, statically inflated, or both, with either pure oxygen or nitrous oxide, 50 per cent, in oxygen. All groups had similar compliance and shunt values before operation and sustained significant decreases in compliance and increases in shunt 30 minutes after bypass. Calves exposed to positive-pressure breathing during bypass had higher shunt and lower compliance values after bypass and postoperatively than those not exposed to mechanical ventilation, irrespective of the inflating gas or presence or absence of any amount of static airway pressure. Animals not ventilated during bypass had compliance and shunt values that were not significantly different from preoperative values, while calves that were ventilated had compliance and shunt values that were still significantly altered two hours postoperatively. These data demonstrate that positive-pressure breathing during bypass decreases pulmonary compliance after bypass and postoperatively and increases intrapulmonary shunt, but that the gas inflating the lungs during bypass does not influence either of these variables. The findings also suggest that static pulmonary inflation during bypass offers no advantage over allowing the lungs to remain collapsed.     

Extracorporeal membrane oxygenation for postoperative cardiac support in children

Prolonged circulatory support for cardiac failure has been increasingly successful in adults but has had very limited use in children. From January 1982 to December 1985, 13 children with postoperative cardiac failure refractory to conventional therapy were treated with extracorporeal membrane oxygenation. Ages ranged from 9 days to 17.6 years (mean = 3.8 years); weights ranged from 2.8 to 50 kg (mean = 13.8 kg). Seven patients had obstructive lesions of the right ventricle, such as pulmonary stenosis and tetralogy; the other patients had tricuspid atresia, truncus arteriosus, complete transposition, total anomalous pulmonary venous connection, pericardial tamponade, and a drug reaction after heart transplantation. One patient (nonsurvivor), who could not be separated from cardiopulmonary bypass, required extracorporeal membrane oxygenation in the operating room. In the remaining 12, the interval between operation and the start of extracorporeal membrane oxygenation ranged from 9 to 50 hours (mean = 22.2 hours). Four patients were cannulated through the groin and nine through the chest. Peak flows ranged from 1.05 to 2.74 L/min/m2 (mean 1.92 L/min/m2). Duration of oxygenator support ranged from 12 hours to 9 days (mean = 3.4 days). Seven patients required reexploration for bleeding. Renal insufficiency developed in five patients, four of whom underwent hemodialysis or ultrafiltration during extracorporeal membrane oxygenation. Two patients had evidence of clots in the oxygenator circuit. Seven patients were weaned from extracorporeal membrane oxygenation. Failure to wean from the oxygenator was related to neurologic sequelae of prolonged hypotension before institution of oxygenation in three patients. Mediastinitis developed in three of the seven patients who were weaned. One of these three died in the hospital 74 days after being weaned from the oxygenator. There has been one late death 6 months after oxygenator support was withdrawn. At most recent examination, five children were well, with normal cardiac function 7 months to 4.3 years postoperatively (mean = 32 months). This series suggests that profound cardiac insufficiency in children after cardiac operations can be successfully managed with extracorporeal membrane oxygenation with excellent functional recovery, although major complications are common in this critically ill group of patients.