ECMO in adults with congenital heart disease - Analysis of a national discharge database

Kops, Samantha; White, Shelby; Klewer, Scott E.; Andrews, Jennifer; Seckeler, Michael D.

doi:10.1016/j.ijcchd.2022.100366

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…When ECMO is used for any reason in ACHD patients, it carries a mortality of 50%-70%, depending on the indication. [17][18][19] As the overall ECMO use in adult patients, including those listed for transplantation, continues to increase rapidly, 20 we were interested in seeing the impact of this evolving landscape on ACHD patients. The current study focused on ACHD patients listed for transplant with ECMO and the impact of the policy change on outcomes by using an interrupted time series analysis.…”

Section: Discussionmentioning

confidence: 99%

“…As these patients deteriorate clinically, ECMO may be a reasonable rescue. When ECMO is used for any reason in ACHD patients, it carries a mortality of 50%–70%, depending on the indication 17–19 . As the overall ECMO use in adult patients, including those listed for transplantation, continues to increase rapidly, 20 we were interested in seeing the impact of this evolving landscape on ACHD patients.…”

Section: Discussionmentioning

confidence: 99%

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Impact of new allocation policy on waitlist and transplant outcomes of adult congenital heart patients supported with ECMO

Deshpande,

Das,

Kumar

et al. 2024

Artificial Organs

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BackgroundThe use of ECMO as a bridge to heart transplantation has been growing rapidly in all heart transplant recipients since the implementation of the new UNOS allocation policy; however, the impact on adult congenital heart disease (ACHD) patients is not known.MethodsWe analyzed the UNOS data (2015–2021) for ACHD patients supported with extracorporeal membrane oxygenation (ECMO) during the waitlist, before and after October 2018, to assess the impact on the waitlist and posttransplant outcomes. We compared the characteristics and outcomes of ACHD patients with or without ECMO use during the waitlist and pre‐ and postpolicy changes.ResultsA total of 23 821 patients underwent heart transplantation, and only 918 (4%) had ACHD. Out of all ACHD patients undergoing heart transplants, 6% of patients in the prepolicy era and 7.6% in the postpolicy era were on ECMO at the time of listing. Those on ECMO were younger and sicker compared to the rest of the ACHD cohort. Those on ECMO had similar profiles pre‐ and postpolicy change; however, there was a very significant decrease in the waitlist time [136 days (IQR 29–384) vs. 38 days (IQR 11–108), p = 0.01]. There was no difference in waitlist mortality; however, competing risk analyses showed a higher likelihood of transplantation (51% vs. 29%) and a lower likelihood of death or deterioration (31% vs. 42%) postpolicy change. Long‐term outcomes posttransplant for those supported with ECMO compared to the non‐ECMO cohort are similar for ACHD patients, although there was higher attrition in the first year for the ECMO cohort.ConclusionThe new allocation policy has resulted in shorter waitlist times and a higher likelihood of transplantation for ACHD patients supported by ECMO. However, the appropriate use of ECMO and the underuse of durable circulatory support devices in this population need further exploration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of new allocation policy on waitlist and transplant outcomes of adult congenital heart patients supported with ECMO

Deshpande,

Das,

Kumar

et al. 2024

Artificial Organs

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show abstract

“…In situations where biventricular support and oxygenation support is needed, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) should be considered. One retrospective study showed that patients with ACHD who required ECMO had longer lengths of stay and suffered more complications than those without ACHD [ 59 ]. When deploying VA-ECMO, reviewing the congenital anatomy to understand aortic and cavo-atrial connections is key to ensuring that arterial and venous cannula are well positioned.…”

Section: Primary Cardiac Diseasementioning

confidence: 99%

Caring for the Critically Ill Adult Congenital Heart Disease Patient

Das,

Rampersad,

Ghobrial

2024

Curr Cardiol Rep

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Purpose of Review This review aims to discuss the unique challenges that adult congenital heart disease (ACHD) patients present in the intensive care unit. Recent Findings Recent studies suggest that ACHD patients make up an increasing number of ICU admissions, and that their care greatly improves in centers with specialized ACHD care. Common reasons for admission include arrhythmia, hemorrhage, heart failure, and pulmonary disease. Summary It is critical that the modern intensivist understand not only the congenital anatomy and subsequent repairs an ACHD patient has undergone, but also how that anatomy can predispose the patient to critical illness. Additionally, intensivists should rely on a multidisciplinary team, which includes an ACHD specialist, in the care of these patients.

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Novel Therapeutic Strategies in Heart Failure in Adult Congenital Heart Disease: of Medicines and Devices

Vaikunth

Sundaravel

Saef

et al. 2023

Curr Heart Fail Rep

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ECMO in adults with congenital heart disease - Analysis of a national discharge database

Cited by 4 publications

References 14 publications

Impact of new allocation policy on waitlist and transplant outcomes of adult congenital heart patients supported with ECMO

Impact of new allocation policy on waitlist and transplant outcomes of adult congenital heart patients supported with ECMO

Caring for the Critically Ill Adult Congenital Heart Disease Patient

Novel Therapeutic Strategies in Heart Failure in Adult Congenital Heart Disease: of Medicines and Devices

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