Veno-Arterial Extracorporeal Membrane Oxygenation for Postcardiotomy Refractory Hemorrhage in Children

Authors

  • Yu Jin Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
  • Yongli Cui Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
  • Zhengyi Feng Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
  • He Wang Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
  • Jia Liu Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
  • Xin Duan Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
  • Jinping Liu Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China

DOI:

https://doi.org/10.59958/hsf.7761

Keywords:

extracorporeal membrane oxygenation, refractory hemorrhage, postcardiotomy, pediatric

Abstract

Background: Refractory hemorrhage is generally considered a relative contraindication to the application of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Previous reports have presented the use of ECMO in the presence of various hemorrhages. Methods: Our clinical experience involves six pediatric patients supported with ECMO for postcardiotomy refractory hemorrhage. Results: All patients were weaned from ECMO successfully. Only one patient died of protein-losing enteropathy two months after ECMO weaning. The ECMO duration ranged from 32 to 134 hours. Conclusion: In our experience, ECMO could be used for postcardiotomy refractory hemorrhage. The timing of ECMO implantation, anticoagulation regimen and auxiliary measures are the keys to successful treatment.

References

Vivacqua A, Koch CG, Yousuf AM, Nowicki ER, Houghtaling PL, Blackstone EH, et al. Morbidity of bleeding after cardiac surgery: is it blood transfusion, reoperation for bleeding, or both? The Annals of Thoracic Surgery. 2011; 91: 1780–1790.

Brown G, Moynihan KM, Deatrick KB, Hoskote A, Sandhu HS, Aganga D, et al. Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure. ASAIO Journal (American Society for Artificial Internal Organs: 1992). 2021; 67: 463–475.

Fu KX, Ng BHZ, Chua MHX. A unique case of acute brain haemorrhage with left ventricular systolic failure requiring ECMO. BMC Pediatrics. 2019; 19: 278.

Vobruba V, Grus T, Mlejnsky F, Belohlavek J, Hridel J, Lambert L. Management of severe pulmonary hemorrhage in a neonate on veno-arterial ECMO by the temporary clamping of the endotracheal tube - a case report. Perfusion. 2018; 33: 77–80.

Ogawa F, Sakai T, Takahashi K, Kato M, Yamaguchi K, Okazaki S, et al. A case report: Veno-venous extracorporeal membrane oxygenation for severe blunt thoracic trauma. Journal of Cardiothoracic Surgery. 2019; 14: 88.

Pacheco Claudio C, Charbonney E, Durand M, Kolan C, Laskine M. Extracorporeal membrane oxygenation in diffuse alveolar hemorrhage secondary to systemic lupus erythematosus. Journal of Clinical Medicine Research. 2014; 6: 145–148.

Jin Y, Feng Z, Zhao J, Hu J, Tong Y, Guo S, et al. Outcomes and factors associated with early mortality in pediatric postcardiotomy veno-arterial extracorporeal membrane oxygenation. Artificial Organs. 2021; 45: 6–14.

Jin Y, Cui Y, Zhang Y, Zhang P, Bai L, Li Y, et al. Hemostatic complications and systemic heparinization in pediatric post-cardiotomy veno-arterial extracorporeal membrane oxygenation failed to wean from cardiopulmonary bypass. Translational Pediatrics. 2022; 11: 1458–1469.

Jin Y, Gao P, Zhang P, Bai L, Li Y, Wang W, et al. Mortality prediction in pediatric postcardiotomy veno-arterial extracorporeal membrane oxygenation: A comparison of scoring systems. Frontiers in Medicine. 2022; 9: 967872.

Haizinger B, Gombotz H, Rehak P, Geiselseder G, Mair R. Activated thrombelastogram in neonates and infants with complex congenital heart disease in comparison with healthy children. British Journal of Anaesthesia. 2006; 97: 545–552.

Willems A, Anders MM, Garcia AV, Vogel AM, Yates AR, Muszynski JA, et al. Management of Extracorporeal Membrane Oxygenation Anticoagulation in the Perioperative Period: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatric Critical Care Medicine: a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2024; 25: e53–e65.

Hu Z, Feng X, Zhang B, Huang J. Rare cause of diffuse alveolar haemorrhage and subconjunctival haemorrhage rescued by extracorporeal membrane oxygenation and rituximab. BMJ Case Reports. 2022; 15: e250025.

Wang C, Zhang L, Qin T, Xi Z, Sun L, Wu H, et al. Extracorporeal membrane oxygenation in trauma patients: a systematic review. World Journal of Emergency Surgery. 2020; 15: 51.

Repessé X, Au SM, Bréchot N, Trouillet JL, Leprince P, Chastre J, et al. Recombinant factor VIIa for uncontrollable bleeding in patients with extracorporeal membrane oxygenation: report on 15 cases and literature review. Critical Care (London, England). 2013; 17: R55.

Schaefer AK, Latus M, Riebandt J, Goliasch G, Bernardi MH, Laufer G, et al. Bleeding and thrombotic events in post-cardiotomy extracorporeal life support. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 2023; 63: ezad072.

Published

2024-09-11

How to Cite

Jin, Y., Cui, Y., Feng, Z. ., Wang, H., Liu, J., Duan, X., & Liu, J. (2024). Veno-Arterial Extracorporeal Membrane Oxygenation for Postcardiotomy Refractory Hemorrhage in Children. The Heart Surgery Forum, 27(9), E1029-E1034. https://doi.org/10.59958/hsf.7761

Issue

Vol. 27 No. 9 (2024)

Section

Article

Copyright (c) 2024 The Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Author Disclosure & Copyright Transfer Agreement