Abstract:

Objective To summarize the intensive care experience of extracorporeal membrane oxygenation (ECMO) and left ventricular assist device (LVAD) in children with refractory heart failure. Methods Thirteen children having undergone operation for complicated congenital heart disease and 1 child with fulminant myocarditis received mechanical circulatory support due to refractory heart failure. There were 8 children in ECMO group and 6 children in LVAD group. The mean arterial pressure, central venous pressure, pressure of right atrium, pressure of left atrium, serum lactate concentration and oxygen saturation of mixed venous blood were monitored during mechanical circulatory support. The dosage of inotropic medicine was adjusted, the activated coagulation time was maintained between 150 s and 180 s, hematocrit between 30% and 35%, and platelet count >80 000/mm3. The mechanical circulatory support was weaned off when blood pressure was stable, pulse pressure was no lower than 20 mmHg, and left ventricular ejection fraction reached 50%. Results The mean time of mechanical circulatory support was (147±152) h in ECMO group and LVAD group. During the mechanical circulatory support, the blood pressure increased from (48.1±5.2) mmHg to (60.2±7.8) mmHg (P<0.05), while the serum lactate concentration decreased from (5.1±0.8) mmol/L to (3.6±0.5) mmol/L (P<0.05). The survival rate of weaning off was 57.1% (8/14), and the survival rate of hospital discharge was 42.9% (6/14). The major complication was severe bleeding in thoracic and abdominal cavity (63.7%). Four children had indifferent mind (28.6%), and 8 had multiple organ dysfunction (57.1%). During the follow up of 4 to 26 months, the left ventricular ejection fraction was no less than 50%, the cardiac function was class Ⅱ,the growth of children was significantly improved, and mild to moderate neural sequela was found in 2 children. Conclusion Mechanical circulatory support plays an effective role in the treatment of children having undergone operation for refractory heart failure. ECMO is more appropriate for neonates, infant and those with complicated congenital heart disease. Bleeding is the severe complication in mechanical circulatory support.

Key words: mechanical circulatory support, extracorporeal membrane oxygenation, left ventricular assist device, congenital heart disease, heart failure, children