Major surgical intervention during extracorporeal membrane oxygenation.

Of 135 patients treated with extracorporeal membrane oxygenation (ECMO) between January 1987 and December 1989, 19 (14.0%) patients underwent surgical procedures while on ECMO. Thirteen (68%) patients had operations related to hemorrhage, including cannula site (6), mediastinal (1), hemoperitoneum (3), and hemothorax (3). Six of 13 patients required repetitive operations for bleeding; 4 of 6 died. Six (35%) patients had operations for congenital pathology including patent ductus (PDA) ligation (2), repair of transposition of the great vessels (2), repair of coarctation (1), and repair of congenital diaphragmatic hernia (3). One patient had multiple simultaneous procedures performed. Of these 6 patients, 4 were decannulated immediately and 2 were decannulated within 28 hours following surgery without any bleeding complications. Fifteen of 19 patients were operated on in the neonatal intensive care unit. The 4 remaining patients required transport on ECMO to the surgical suite. Thirteen of the 19 patients requiring surgical intervention on ECMO survived. In the 13 survivors, the mean time to decannulation postoperative was 45 hours, and in those that died it was 90 hours. Our experience suggests that surgical intervention while on ECMO is technically feasible with the best results achieved when rapid discontinuation of ECMO can be accomplished postoperatively. Due to this fact major surgical intervention should be postponed if possible until near the conclusion of the ECMO therapy.