Exploration of left ventricular decompression in children undergoing extracorporeal membrane oxygenation
10.3760/cma.j.issn.1673-4912.2025.03.007
- VernacularTitle:左心室减压在儿童体外膜肺氧合的应用探讨
- Author:
Lijuan LI
1
;
Zhongxuan LAO
;
Yuyin YE
;
Jiaxin ZHUANG
;
Yanqin CUI
Author Information
1. 广州医科大学附属妇女儿童医疗中心 510000
- Publication Type:Journal Article
- Keywords:
Left ventricular decompression;
Extracorporeal membrane oxygenation;
Children
- From:
Chinese Pediatric Emergency Medicine
2025;32(3):197-201
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the feasibility and efficacy of left ventricular decompression in pediatric patients supported by extracorporeal membrane oxygenation（ECMO）.Methods:The clinical data of 15 children who underwent left ventricular decompression during ECMO in the cardiac intensive care unit（CICU）of Guangzhou Women and Children's Medical Center from February 2021 to August 2023 were retrospectively analyzed.Results:Among the 15 patients，there were 8 males and 7 females,with a median age of 1.1 years old（20 days to 15 years old）and a median weight of 8.5（3.1 to 38.0）kg. Cardiac pathologies varied，including hypertrophic obstructive cardiomyopathy(1 case),left coronary artery abnormalities originating from the pulmonary artery（3 cases），aortic coarctation with ventricular septal defect（1 case），complete transposition of great arteries with ventricular septal defect（1 case），ventricular septal defect with severe mitral valve insufficiency（1 case），fulminant myocarditis（5 cases），tetralogy of Fallot（1 case），ascending aortic aneurysm with aortic valve insufficiency（1 case），and Kawasaki disease complicated with giant aneurysm（1 case）. The venous-arterial ECMO mode was used in all 15 children,9 cases were intubated centrally and 6 cases were intubated peripherally. The reasons for ECMO：low cardiac output（8 cases），cardiogenic shock（5 cases），and frequent ventricular tachycardia and ventricular fibrillation（2 cases）. Extracorporeal cardiopulmonary resuscitation was performed in 3 cases. The median duration of mechanical ventilation was 248 (142-590) h,the median CICU stay was 18 (7-26) d,and the median hospital stay was 28 (7-37) d. Of the 15 children,7 cases underwent emergency left ventricular decompression through a small sternal incision,with a mean decompression time of ECMO-assisted 12.2(9-22) h，and 8 cases underwent selective left ventricular decompression through a median sternal incision. Left ventricular systolic function improved significantly after decompression in all 15 patients，of whom 12 cases were successfully withdrew off ECMO and 10 cases of them survived.Conclusion:Left ventricular decompression can improve the cardiac dysfunction in children with ECMO，reduce the occurrence of complications，and increase the success rate and survival rate of ECMO.
