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Preoperative versus postoperative extracorporeal life support in neonatal cardiac patients

Division of Neonatology, Department of Pediatrics, Kosair Children’s Hospital, Louisville

Dan L Stewart

Division of Neonatology, Department of Pediatrics, Kosair Children’s Hospital, Louisville

Tonya W Robinson

Division of Neonatology, Department of Pediatrics, Kosair Children’s Hospital, Louisville

Larry N Cook

Division of Neonatology, Department of Pediatrics, Kosair Children’s Hospital, Louisville

Erle H Austin, III

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky

The aim of this study is to document our experience with the use of extracorporeal life support (ECLS) in the neonatal cardiac patient, to detect differences in the morbidity and mortality between patients who required ECLS preoperatively and those who required ECLS postoperatively, and to determine the long-term effects of these morbidities.

A chart review was undertaken of all neonatal cardiac patients who required ECLS between May 1985 and July 1994 at Kosair Children’s Hospital, Louisville, Kentucky.

Twenty-three neonatal cardiac patients had received preoperative or postoperative ECLS with an overall survival rate of 35%. Our preoperative and postoperative patients had similar demographics, diagnoses, decannulation rates and survival rates. However, patients receiving postoperative ECLS more frequently required more than two inotropes (p < 0.001), had an increased incidence of renal failure (p < 0.02), had more central nervous system abnormalities on brain imaging studies (p < 0.004), and had a longer hospital stay (p < 0.05). Follow-up testing of survivors yielded normal Bayley Scale of Infant Development (BSID) scores in half of the patients.

Survival in the two groups was similar, but a significant difference in morbidity was found. Except for severe intracranial abnormalities, the morbidity was shown to be reversible on follow-up examination. We recommend the continued use of ECLS for neonatal cardiac patients who require preoperative or postoperative support even when severe renal failure ensues or minor abnormalities are detected on brain imaging studies.

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