ATS October 2009: Bautista-Hernandez et al. Preoperative extracorporeal membrane oxygenation as a bridge to cardiac surgery in children with congenital heart disease. Ann Thorac Surg 2009; 88(4):1306-11.

In this month’s Annals, the Boston Children’s hospital group analyze their experience with ECMO in cardiac patients to provide preoperative stabilization after acute cardiac or respiratory failure in patients with congenital heart disease. 26 children with unrepaired congenital heart disease supported with ECMO for acute cardiac or respiratory failure as bridge to a definitive or palliative cardiac surgical procedure were identified in the database. Data collection included patient demographics, indication for ECMO, details regarding ECMO course and complications, and survival to hospital discharge. Median age and weight at ECMO cannulation were,0.12 months (0 to 193) and 4 kg (1.8 to 67 kg). Sixteen patients (62%) survived to hospital discharge. Variables associated with mortality included inability to decannulate from ECMO after operation (p = 0.02)and longer total duration of ECMO (p = 0.02). No difference in outcome was found in patients with single and biventricular anatomy. The authors concluded that ECMO used as a bridge to surgery is a useful modality and has a role in salvaging severely ill as yet unoperated.

This important paper lends support to an important but previously undocumented concept, and further expands the role of ECLS pediatric in cardiac surgery. Clearly the results in this series justify the considerable effort and expense required. Please read the full article at http://ats.ctsnetjournals.org/cgi/content/full/88/4/1306 and add your comments in the forum, regarding any aspects of this paper or of the general strategy.