LAUSR

Aim and objectives To assess ECMO utilization and outcome in Neonatal & Pediatric CCU. To identify predictors for poor outcome among children undergoing ECMO after cardiac surgery. Methods It was retrospective study that included cohort of paediatric patients (<18 years age) from January 2016 to 15th August 2018, who required ECMO support post operatively. Preoperative, Operative, ECMO and postoperative variables are collected from case files and HIMS. Data was entered in a pre-approved proforma. Approval was obtained from ethical and research committee. Results 37 patients matched inclusion criteria. 62.2% were male and 37.8% were female. The indications for ECMO support were ‘unable to wean from cardiopulmonary bypass’ (75.8%), ‘low cardiac output state postoperatively despite maximum medical therapy’ (16.2%), hypoxia (5.4%) and E-CPR (2.7%). All patients were centrally cannulated and put on V-A ECMO. Mean ECMO duration was 145.3 (26.6 hours to 541.6 hours).26 (70.3%) patients were successfully decannulated from ECMO. 17 (45.9%) patients survived to discharge. Common pathologies requiring postoperative ECMO support requirement were TGA (20/37) followed by TOF (6/37). Outcome for children with TOF was very poor (100% Mortality). Blood product requirement was much higher in those who could not be decannulated. Among the patients who had sepsis on ECMO, survival was 31% Conclusion Decannulation percentage was 70.3% and overall survival was 46%. This may be partially attributed to higher incidence of sepsis and malnutrition in ICUs in Indian subcontinent compared to developed countries. Outcome was poor in TOF who required ECMO support post operatively. Outcome was better among patients who were put on ECMO in operation theatre (Elective vs Emergency). Increased requirement for blood products show trend towards poor outcome.