Post Cardiotomy ECMO improves survival in pediatric patients with failed CPB weaning
South Korea: A recent study published in Frontiers in Pediatrics found that in cases of failed cardiopulmonary bypass (CPB) weaning and deterioration in ICU, post-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) is an effective approach to support neonates and pediatric patients.
"ECMO, although improves survival, morbidity and mortality remain high, particularly in neonates and pediatric patients with single ventricle physiology. Most genetic conditions alone should not be considered a contraindication to ECMO support," Hwa Jin Cho, Chonnam National University Children's Hospital and Medical School, Gwangju, South Korea, and colleagues wrote in their study.
Previous studies have shown PC-ECMO to be a rescue therapy for neonates and pediatric patients with failed CPD weaning or those who deteriorate in the intensive care unit (ICU) due to several reasons including cardiac arrest, low cardiac output syndrome (LCOS), and respiratory failure.
Against the above background, the researchers' team conducted a systematic review and meta-analysis for assessing survival in neonates and pediatric patients requiring PC-ECMO and sought the difference in survival by each indication for PC-ECMO.
The study included neonates and pediatric patients who require PC- ECMO. The analysis included twenty-six studies with a total of 186,648 patients and the proportion of the population who underwent PC-ECMO was 2.5% (2,683 patients).
Based on the study, the researchers reported the following:
- The overall pooled proportion of survival in this population was 43.3%.
- The survival by indications of PC-ECMO was 44.6% for CPB weaning failure, 47.3% for LCOS, 37.6% for cardiac arrest, and 47.7% for respiratory failure.
- Survival from PC-ECMO for single ventricle or biventricular physiology was reported by 12 studies.
- The risk ratio (RR) was 0.74 for survival in patients with single ventricle physiology.
- Eight studies reported survival after PC-ECMO for genetic conditions.
- The RR was 0.93 for survival in patients with genetic conditions.
"PC-ECMO is an effective approach to support neonates and pediatric patients in case of deterioration in ICU and failed CPB weaning," the researchers wrote. "Even though ECMO seems to improve survival, there is a high incidence of morbidity and mortality, especially in neonates and children with h single ventricle physiology."
"Most genetic conditions alone should not be considered a contraindication to ECMO support, further studies are required to determine which genetic abnormalities are associated with favorable outcomes," they conclude.
Reference:
Cho HJ, Choi I, Kwak Y, Kim DW, Habimana R and Jeong I-S (2022) The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis. Front. Pediatr. 10:869283. doi: 10.3389/fped.2022.869283
