follow-up[ 26 ]. In pediatric cardiac patients, ECPR has a survival to discharge of
71% in nonsurgical patients and 46% in postoperative patients[ 21 ]. In hospital
cardiac arrest had the best neurologic outcomes and survival to discharge in all
patients after ECPR.
IV. Complications
In general, the complications associated with ECLS are mechanical or
patient related. Mechanical causes are the pathology of the anatomy of ECLS
whereas patient related issues are the pathophysiology. The most common
mechanical problems are clots in the circuit and cannula problems. The most
common patient related complications are renal failure requiring dialysis,
hemolysis and intracranial hemorrhage (ICH) or stroke. Mechanical issues are
discovered through constant surveillance. Often, checklists are used to assess
different aspects of the circuit: venous cannula, venous reservoir (“bladder”),
pump, oxygenator, heat exchanger, arterial cannula, and environment.[ 4 ]
Patient complications include renal failure, hemolysis, ICH,
bleeding/thrombocytopenia/coagulopathy, hypertension, myocardial stun, and
sepsis. Oliguria and capillary leak resulting in decreased renal perfusion is
common with ECLS. In the presence of elevated creatinine or lack of response to
IV furosemide, anatomic anomalies in the kidney should be excluded with an
ultrasound. A dialysis filter added to the circuit can facilitate removal of additional
fluid to help pulmonary status and prevent further kidney injury. Hemolysis can
occur due to red blood cell trauma during extracorporeal support, which is often