Lessons learned from ECMO support in pediatric patients with D-transposition of the great arteries: preoperative, intraoperative and postoperative

Lijun Yang; Lifen Ye; Jiangen Yu; Jianhua Li; Zewei Zhang; Qiang Shu; Ru Lin

doi:10.1136/wjps-2021-000273

Lessons learned from ECMO support in pediatric patients with D-transposition of the great arteries: preoperative, intraoperative and postoperative

World J Pediatr Surg. 2021 Sep 28;4(4):e000273. doi: 10.1136/wjps-2021-000273. eCollection 2021.

Authors

Lijun Yang¹, Lifen Ye¹, Jiangen Yu², Jianhua Li², Zewei Zhang², Qiang Shu², Ru Lin¹

Affiliations

¹ Extracorporeal Circulation and Extracorporeal Life Support, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
² Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) support on D-transposition of the great arteries (D-TGA) carries formidable challenges.

Methods: A retrospective study was performed on pediatric patients with D-TGA supported by ECMO from July 2007 to December 2019. This study summarized the clinical experience of ECMO support in pediatric patients with D-TGA preoperative, intraoperative, and postoperative.

Results: Overall, 16 children with D-TGA received ECMO support during this period. Two (2 of 16) were supported before cardiac surgery, 3 (3 of 16) were supported postoperatively in the intensive care unit, and 11 (11 of 16) failed to wean off cardiopulmonary bypass. Two cases of preoperative ECMO support for patients with D-TGA with an intact ventricular septum and restrictive atrial septum due to severe hypoxemia died. In this study, D-TGA with coronary artery malformation and other complicated deformities died (8 of 14), whereas uncomplicated D-TGA without coronary artery malformation all survived (6 of 14). The wean-off rate of ECMO patients supported in D-TGA was 62.5% (10 of 16), while the 30-day survival rate was 44% (7 of 16).

Conclusion: Although a promising ECMO weaning rate was obtained, 30-day survival of this population was frustrating, mainly attributed to the original anatomy of coronary arteries and the concomitant deformities.

Keywords: congenital abnormalities; extracorporeal membrane oxygenation; intensive care; neonatal; pediatrics.