Absence of rapid deployment extracorporeal membrane oxygenation (ECMO) team does not preclude resuscitation ecmo in pediatric cardiac patients with good results.

Department of Thoracic and Cardiovascular Surgery, Children's Hospital La Timone, Marseille, France.
ASAIO journal (American Society for Artificial Internal Organs: 1992) (Impact Factor: 1.39). 01/2007; 53(6):692-5. DOI: 10.1097/MAT.0b013e318151412f
Source: PubMed

ABSTRACT We evaluated the results of using extracorporeal membrane oxygenation (ECMO) as resuscitation for cardiac patients undergoing cardiopulmonary resuscitation (CPR) in our setting where neither perfusionists nor surgeons are always on site, and no circuit may be ready. Between 2003 and 2006, we used ECMO for all cardiac patients who underwent cardiac arrest in the pediatric intensive care unit (PICU) or Cath Laboratory. We reviewed retrospectively 14 consecutive files (15 episodes). Mean CPR time before ECMO institution was 44 minutes (10-110 minutes). The surgeons, perfusionist, and scrub nurse, not on site for three of these patients, had to be called in simultaneously with institution of CPR. Two died on ECMO, the third one was successfully transplanted after 5 days. Globally, 10 patients could be weaned (66%). Eight patients (57%) survived to hospital discharge, seven without obvious neurological damage. One patient was bridged to a left ventricular assist device (LVAD) and was eventually successfully transplanted. He had an ischemic brain lesion with good recuperation and no sequel. We obtained good results with resuscitation ECMO in our setting where a permanently on-site rapid deployment ECMO team is not present at all times.

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    ABSTRACT: L’assistance circulatoire pédiatrique ne s’improvise pas. Elle possède de nombreuses spécifi cités qui doivent être connues et masîtrisées par l’ensemble de l’équipe soignante. Plus l’enfant est petit, plus il est intolérant aux approximations techniques et thérapeutiques. L’optimisation de chaque élément développé dans ce chapitre est fondamentale pour espérer mener à bien cette thérapeutique souvent ultime. L’ECMO pédiatrique comporte ses propres limites. Le faible poids de l’enfant et surtout son immaturité physiologique restent un facteur limitant. De même, les indications ne sont pas toujours faciles à poser, tant par excès que par défaut. Le développement de l’ECMO de ressuscitation étend ces indications. Seule une activité régulière dans un centre médico-chirurgical spécialisé, disposant de moyens humains et matériels adaptés, peut garantir des résultats satisfaisants. Cependant, le développement des techniques de transport des patients sous assistance circulatoire permet un véritable fonctionnement en réseau de l’ensemble des centres de réanimation pédiatrique. Même éloigné d’un centre de chirurgie cardiaque pédiatrique, chaque enfant présentant une indication d’ ECMO doit désormais pouvoir en bénéfi cier.

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