Pediatric Extracorporeal Membrane Oxygenation Support as Treatment for Refractory Cardiogenic Shock

none9noPurpose: Extracorporeal membrane oxygenation (ECMO) remains the most commonly used tool as mechanical circulatory support in children. We report our experience on pediatric veno-arterial (v-a) ECMO support as treatment of refractory cardiogenic shock (CS). Methods: Between October 2004 and August 2015, 54 consecutive pediat- ric patients (31 male; age: 3.5±5.1 years, range: 1-17 years; mean weight: 14.3±11.1 kg, range: 2.8-60.5 kg) were supported on Levitronix CentriMag (n=41) and RotaFlow (n=13) v-a ECMO, at our institution. Indications for support were: failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n=35) and early donor graft failure (n=4); primary CS on congenital heart defect (n=4); acute myocarditis (n=3); and CS on chronic heart failure (n=8). Results: A central setting was established in 43 (79.6%) patients while peripherally in 11 (20.4%). Overall mean support time was 11.9±9.7 days (range: 1-43 days). Thirty-one (57.4%) patients died on ECMO mostly due to multiple organ dysfunction and sepsis. Overall success rate, in terms of survival on ECMO (n=23), weaning from mechanical support (n=13, 24.1%), bridge to heart transplantation (n=7, 12.9%) and bridge to long-term Berlin Heart Excor ventricular assist device (n=3, 5.5%), was 42.6%. Only fourteen (25.9%) patients were discharged since significant myocardial dys- function persisted or pulmonary hypertensive events occurred after weaning from ECMO. Multivariate analysis identified cardio-pulmonary resuscita- tion before ECMO, congenital heart defect, post-cardiotomy CS, and time on mechanical support as significant (p<0.001) predictors of mortality on ECMO. After adjusting per cohort of patients, univentricular physiology resulted to be a factor significantly (p