Post-cardiotomy ECMO in pediatric and congenital heart surgery: impact of team training and equipment in the results

Introduction

Post-cardiotomy myocardial dysfunction requiring mechanical circulatorysupport occurs in about 0.5% of cases. In our environment, the use ofextracorporeal membrane oxygenation has been increasing in recent years.

Objective

To evaluate the impact of investment in professional training and improvementof equipment in the rate of weaning from extracorporeal membrane oxygenationand survival.

Methods

A retrospective study. Fifty-six pediatric and/or congenital heart patientsunderwent post-cardiotomy extracorporeal membrane oxygenation at ourinstitution between November 1999 and July 2014. We divided this period intotwo phases: phase I, 36 cases (before the structuring of the extracorporealmembrane oxygenation program) and phase II, 20 cases (after theextracorporeal membrane oxygenation program implementation) with investmentin training and equipment). Were considered as primary outcomes:extracorporeal membrane oxygenation weaning and survival to hospitaldischarge. The results in both phases were compared using Chi-square test.To identify the impact of the different variables we used binary logisticregression analysis.

Results

Groups were comparable. In phase I, 9 patients (25%) were weaned fromextracorporeal membrane oxygenation, but only 2 (5.5%) were discharged. Inphase II, extracorporeal membrane oxygenation was used in 20 patients,weaning was possible in 17 (85%), with 9 (45%) hospital discharges(P<0.01). When the impact of several variables ondischarge and weaning of extracorporeal membrane oxygenation was analyzed,we observe that phase II was an independent predictor of better results(P<0.001) and need for left cavities drainage wasassociated with worse survival (P=0.045).

Conclusion

The investment in professional training and improvement of equipmentsignificantly increased extracorporeal membrane oxygenation results.