Abstract
Introduction. In the last decade, Russia has significantly increased the number of open heart operations performed in children with complex congenital heart defects, new techniques are being developed and the range of pathologies in which surgical intervention becomes possible is expanding. Naturally, with such rapid development of this field of medicine increases the risk of various complications, the main of which are acute heart and/or respiratory failure, often resistant to standard drug therapy. Currently, the only effective way to combat this problem in the early postoperative period is the use of extracorporeal membrane oxygenation (ECMO). Objective: to present the experience of using ECMO in newborns and children after cardiac surgery in the development of cardiac and/or respiratory failure in the postperfusion or early postoperative period in the Bakoulev National Medical Research Center for Cardiovascular Surgery.
Material and methods. Study design – retrospective analysis. Patient data were obtained from the analysis of medical records, and dynamic observation was carried out on the basis of outpatient records. The present work is based on the results of examination and treatment of 251 patients from 1999 to 2018, in whom the ECMO method was applied after cardiac surgery. Indications for the ECMO procedure were: inability to disconnect the patient from the heartlung machine after surgery – 129 (51.4%), low cardiac output syndrome in the early postoperative period – 108 (43%), acute respiratory failure – 8 (3.2%), residual pulmonary hypertension – 2 (0.8%), sudden circulatory arrest – 4 (1.6%).
Results.The average duration of ECMO support was 75.9±21.9 hours. 121 (48.2%) of patients were successfully disconnected from ECMO, 67 (27%) patients were discharged from the clinic in a satisfactory condition. The mortality rate was 73%. Predictors of hospital mortality were: blood loss, low cardiac output syndrome, high lactate concentrations before ecmo connection. The most frequent complications – renal failure (47.8%), intracranial hemorrhage (11.2%), persistent myocardial failure (23.1%), rethoracotomy the bleeding (8.8%), sepsis (2%), syndrome of intravascular coagulation (DIC) and trombogenesys (8.8%). Predictors of a favorable outcome of treatment – higher hemoglobin, platelets, low lactate and adequate rate of diuresis.
Conclusion. The analysis of the experience of using the ECMO method showed that the restoration of adequate cardiac activity and gas exchange was noted in 48.2%, but only 27% were discharged from the clinic. Accumulation of experience, expansion of indications and introduction of protocols of management of patients on ECMO, allowed to apply more aggressively this method of auxiliary blood circulation in treatment of cardiac and / or respiratory insufficiency.
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About the authors
- Konstantin V. Shatalov, Dr. Med. Sc., Professor, Head of Department, orcid.org/0000-0003-1120-9363
- Maksim V. Makhalin, Cand. Med. Sc., Senior Researcher, orcid.org/0000-0001-9051-1477
