Considering the vast increase in post-operative paediatric ECMO, defined indicators for initiating ECMO still remain controversial, with limited research into perfusion parameters. This study aimed to assess whether perfusion parameters can indicate the necessity for post-operative ECMO and whether patient outcomes are determined by ECMO duration and the reasons for requiring post-operative ECMO.
A retrospective study of Birmingham Children’s hospital data was undertaken between 2008-2020. Data was collected for 101 ECMO patients, and 3 appropriate control patients were selected who did not require post-operative ECMO. Comparison was undertaken for all ECMO vs. control patients, and between surgical procedure sub-groups. ECMO patients were also divided into the reason for requiring ECMO including low cardiac output syndrome, extracorporeal cardiopulmonary resuscitation, failure to separate from bypass, and respiratory failure to assess short- and long-term outcomes. Duration of ECMO was assessed with short-term outcomes.
The post-operative ECMO rate was 2.3% with a survival rate of 51.5% within the study. Bypass time was significantly longer for ECMO patient’s vs control patients (162.59 and 105.01 minutes respectively, p<0.001), as well as arrest and x-clamp time (24.33 and 17.61 minutes respectively p=0.012, and 80.09 and 64.61 minutes respectively, p=0.002). The initial and final lactate on bypass were significantly increased in ECMO patient’s vs control patients (3.25mmol/L and 2.44mmol/L respectively, p<0.001, and 6.55mmol/L and 4.51mmol/L respectively, p<0.001). Final base excess was more negative in ECMO patients than control patients at -4.88mmol/L and -3.62mmol/L respectively (p=0.002). Similar
results were seen for surgical procedure sub-groups. Duration of ECMO increased mortality after 151 hours. ECPR had poorer survival rates compared to LCOS and FTSB however; there was no difference between long-term survivals.
Overall, perfusion parameters can significantly indicate ECMO requirement. Duration and circumstances for requiring ECMO can impact on short-term outcomes, however, do not affect long-term outcomes.