Pediyatrik kalp cerrahisinde ekstrakorporeal membran oksijenasyonu kullanımı

Ekstrakorporeal membran oksijenasyonu (ECMO), geleneksel tedavi yöntemlerine yanıt vermeyen tüm yaş gruplarında kalp veya solunum yetmezliği olan hastalarda kanıtlanmış bir tedavidir. Komplike konjenital kalp hastalıklı yenidoğan ve infantlarda artan kompleks kalp cerrahisi sonucunda ECMO kullanımı da artmaktadır. Belirgin mortalite ve morbiditeye sahip bu hasta grubunda ortalama sağkalım yaklaşık olarak %40 civarındadır. Hasta seçimi ECMO kullanım başarısı için çok önemlidir. ECMO'nun kullanımında başarının anahtarı deneyimli ve multidisipliner ekip çalışmasıdır. Pediatrik kalp cerrahisinde ECMO yaygın kullanım alanları; standart tedavilere yanıtsız kardiyorespiratuvar yetmezlik, kardiyopulmoner bypasstan ayrılamama ve düşük kardiyak output sendromu sayılabilir. Bu yazıda pediatrik kalp cerrahisinde ECMO'nun endikasyonları ve uygulama alanları değerlendirildi.

Use of extracorporeal membrane oxygenation in pediatric cardiac surgery

Extracorporeal membrane oxygenation (ECMO) is a proven therapy for patients with cardiac or respiratory failure across all age groups who do not respond to conventional treatment modalities. Increasing complex repairs in neonates and infants with complicated congenital heart diseases have led to the increased use of extracorporeal membrane oxygenation (ECMO) support. Use of ECMO in such a high-risk population is associated with significant morbidity and mortality, with an overall survival rate remaining at approximately 40%. Patient selection is important to he success of usage of ECMO. The key to successful outcomes in usage of ECMO is experienced and multidisciplinary teamwork. In pediatric cardiac surgery, common indications for ECMO include cardiorespiratory ailure, lack of response to standard treatment, failure to separate from cardiopulmonary bypass and low cardiac output syndrome. In this article, the indications and applications of ECMO are evaluated in pediatric cardiac surgery.

PDF

___

1. Conrad SA, Rycus PT, Dalton H. Extracorporeal life support registry report 2004. ASAIO J 2005;51(1):4-10.
2. Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 1954;37(3):171-85
3.Lillehei CW. A personalized history of extracorporeal circulation. Trans Am Soc Artif Intern Organs 1982;28:5-16.
4. Kirklin JW, Donald DE, Harshbarger HG, Hetzel PS, Patrick RT, Swan HJ. Studies in extracorporeal circulation. I. Applicability of Gibbon-type pump-oxygenator to human intracardiac surgery: 40 cases. Ann Surgl 1956;144(1):2-8.
5. Bartlett RH, Gazzaniga AB, Jefferies MR, Huxtable RF, Haiduc NJ, Fong SW. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs 1976;22:80-93.
6. Trittenwein G, Fürst G, Golej J, et al. Preoperative ECMO in congenital cyanotic heart disease using the AREC system. Ann Thorac Surg 1997;63(5):1298-302.
7. Itoh H, Kasahara S, Sano S. Risk factor analysis of cardiac ECMO for congenital heart disease. Membrane Oxygenator 2009;32(1):43-6.
8. Luciani GB, Chang AC, Starnes VA. Surgical repair of transposition of the great arteries in neonat es with persistent pulmonary hypertension. Ann Thorac Surg 1996;61(3):800-5.
9. Jaillard S, Belli E, Rakza T, et al. Preoperative ECMO in transposition of the great arteries with persistent pulmonary hypertension. Ann Thorac Surg 2005;79(6):2155-8.
10. Hetzer R, Stiller B. Technology insight: Use of ventricular assist devices in children. Nat Clin Pract Cardiovasc Med 2006;3(7):377-86.
11. Shah SA, Shankar V, Churchwell KB, et al. Clinical outcomes of 84 children with congenital heart disease managed with extracorporeal membrane oxygenation after cardiac surgery. ASAIO J 2005;51(5):517-21.
12. Kim ES, Stolar CJ. ECMO in the newborn. Am J Perinatol 2000;17(7):345-56.
13. Aharon AS, Drinkwater DC Jr, Churchwell KB, et al. Extracorporeal membrane oxygenation in children after repair of congenital cardiac lesion. Ann Thorac Surg 2001;72(6):2095-102.
14. Imamura M, Dossey AM, Jaquiss RD. Reoperation and mechanical circulatory support after repair of anomalous origin of the left coronary artery from the pulmonary artery: A twenty-year experince. Ann Thorac Surg 2011;92(1):167-73.
15. Keszler M, Subramanian KN, Smith YA, et al. Pulmonary management during extracorporeal membrane oxygenation. Crit Care Med 1989;17(6):495-500.
16. Sell LL, Cullen ML, Whittlesey GC, et al. Hemorrhagic complications during extracorporeal membrane oxygenation: Prevention and treatment. J Pediatr Surg 1986;21(12):1087-91.
17. Delmo Walter EM, Stiller B, Hetzer R, et al. Extracorporeal membrane oxygenation for perioperative cardiac support in children I: Experience at the German Heart Institute Berlin (19872005). ASAIO J 2007;53(2):246-54.
18. Jaggers JJ, Forbess JM, Shah AS, et al. Extracorporeal membrane oxygenation for infant postcardiotomy support: Significance of shunt management. Ann Thorac Surg 2000;69(5):1476-83.
19. Mehta U, Laks H, Sadeghi A, et al. Extracorporeal membrane oxygenation for cardiac support in pediatric patients. Am Surg 2000;66(9):879-86.
20. Stiller B, Lemmer J, Merkle F, et al. Consumption of blood products during mechanical circulatory support in children: Comparison between ECMO and a pulsatile ventricular assist device. Intensive Care Med 2004;30(9):1814-20.
21. Drews T, Stiller B, Huebler M, Weng Y, Berger F, Hetzer R. Coagulation management in pediatric mechanical circulatory support. ASAIO J 2007;53(5):640-5.
22. Duncan BW. Mechanical cardiac support in the young. Short-term support: ECMO. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2006;9:75-82.
23. Del Nido PJ. Extracorporeal membrane oxygenation for cardiac support in children. Ann Thorac Surg 1996;61(1):336-41.
24. Black MD, Coles JG, Williams WG, et al. Determinants of success in pediatric cardiac patients undergoing extracorporeal membrane oxygenation. Ann Thorac Surg 1995;60(1):133-8.