Outcomes of Single-Ventricle Patients Supported With Extracorporeal Membrane Oxygenation*

Misfeldt, Andrew; Kirsch, Roxanne; Goldberg, David J.; Mascio, Christopher E.; Naim, Maryam Y.; Zhang, Xumei; Mott, Antonio R.; Ravishankar, Chitra; Rossano, Joseph W.

doi:10.1097/pcc.0000000000000616

Cited by 38 publications

(19 citation statements)

References 21 publications

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“…A retrospective analysis of the KID database of 701 single‐ventricle (SV) patients supported with ECMO was published by Misfeldt et al ECMO support had significantly increased over the years but was still reasonably uncommon. Mortality was 57% and ARF was found to be an independent risk factor for mortality after multivariate analysis (OR 3.3).…”

Section: Discussionmentioning

confidence: 99%

What is new in pediatric ECMO? 2016, a year in review

Roeleveld

2017

European J of Heart Fail

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With the increasing use of extracorporeal membrane oxygenation in children come increasing publications concerning pediatric ECMO. In 2016 important work was done in identifying modifiable risk-factors and possible predictors of mortality in cardiac and respiratory ECMO and risk-estimation scores have been developed for respiratory ECMO patients. Also, increasing important experience is published in the areas of neurodevelopmental follow-up of ECMO survivors. The most relevant publications of 2016 are summarized in this review.

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Section: Discussionmentioning

confidence: 99%

What is new in pediatric ECMO? 2016, a year in review

Roeleveld

2017

European J of Heart Fail

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“…Considering the Berlin Heart EXCORE IDE database, evaluating outcomes for single-ventricle patients, survival of 26 patients was 42% (4). Utilizing the KID (Kids Inpatient Database) to analyze survival in single-ventricle patients who require ECMO allowed for an analysis of 701 patients over 10 years; overall survival was 43%, and importantly, the outcomes did not improve over the decade evaluated (15). Though these are the most informative studies available, each evaluated the outcomes of a heterogenous patient population, with unique anatomy and indications for MCS.…”

Section: Discussionmentioning

confidence: 99%

“…Most consider the survival to hospital discharge of single-ventricle patients who require MCS to be 30-50% (4,(15)(16)(17)(18). When evaluating all patients with a single-ventricle who underwent MCS over a 25-year period at a single institution, of 57 patients, 18 (33%) survived to hospital discharge (16).…”

Section: Discussionmentioning

confidence: 99%

An overview of mechanical circulatory support in single-ventricle patients

et al. 2018

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The population of people with a single-ventricle is continually increasing due to improvements across the spectrum of medical care. Unfortunately, a proportion of these patients will develop heart failure.Often, for these patients, mechanical circulatory support (MCS) represents the only available treatment option. While single-ventricle patients currently represent a small proportion of the total number of patients who receive MCS, as the single-ventricle patient population increases, this number will increase as well.Outcomes for these complex single-ventricle patients who require MCS has begun to be evaluated. When considering the entire population, survival to hospital discharge is 30-50%, though this must be considered with the significant heterogeneity of the single-ventricle patient population. Patients with a single-ventricle have unique anatomy, mechanisms of failure, indications for MCS and the type of support utilized. This has made the interpretation and the generalizability of the limited available data difficult. It is likely that some subsets will have a significantly worse prognosis and others a better one. Unfortunately, with these limited data, indications of a favorable or poor outcome have not yet been elucidated. Though currently, a database has been constructed to address this issue. While the outcomes for these complex patients is unclear, at least in some situations, they are poor. However, significant advances may provide improvements going forward, including new devices, computer simulations and 3D printed models. The most important factor, however, will be the increased experience gained by the heart failure team to improve patient selection, timing, device and configuration selection and operative approach.

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“…Pediatric cardiac surgical programs routinely use extracorporeal membrane oxygenation (ECMO) to rescue surgical patients with cardiopulmonary failure, and predictors of ECMO support in these patients have been well documented . However, predictors of ECMO support in adults after CHD surgery have not been previously reported.…”

Section: Introductionmentioning

confidence: 99%

“…3,6 Pediatric cardiac surgical programs routinely use extracorporeal membrane oxygenation (ECMO) to rescue surgical patients with cardiopulmonary failure, and predictors of ECMO support in these patients have been well documented. [7][8][9][10][11] However, predictors of ECMO support in adults after CHD surgery have not been previously reported. Because adult patients are likely to be active participants in their medical decision making, identifying patients who are at increased risk of requiring ECMO support is important for presurgical discussion and planning.…”

Section: Introductionmentioning

confidence: 99%

Predictors of extracorporeal membrane oxygenation support after surgery for adult congenital heart disease in children's hospitals

Dolgner

Krieger

Wilkes

et al. 2019

Congenital Heart Disease

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Objective Adult congenital heart disease (ACHD) patients who undergo cardiac surgery are at risk for poor outcomes, including extracorporeal membrane oxygenation support (ECMO) and death. Prior studies have demonstrated risk factors for mortality, but have not fully examined risk factors for ECMO or death without ECMO (DWE). We sought to identify risk factors for ECMO and DWE in adults undergoing congenital heart surgery in tertiary care children's hospitals. Design All adults (≥18 years) undergoing congenital heart surgery in the Pediatric Health Information System (PHIS) database between 2003 and 2014 were included. Patients were classified into three groups: ECMO‐free survival, requiring ECMO, and DWE. Univariate analyses were performed, and multinomial logistic regression models were constructed examining ECMO and DWE as independent outcomes. Setting Tertiary care children's hospitals. Results A total of 4665 adult patients underwent ACHD surgery in 39 children's hospitals with 51 (1.1%) patients requiring ECMO and 64 (1.4%) patients experiencing DWE. Of the 51 ECMO patients, 34 (67%) died. Increasing patient age, surgical complexity, diagnosis of single ventricle heart disease, preoperative hospitalization, and the presence of noncardiac complex chronic conditions (CCC) were risk factors for both outcomes. Additionally, low and medium hospital ACHD surgical volume was associated with an increased risk of DWE in comparison with ECMO. Conclusions There are overlapping but separate risk factors for ECMO support and DWE among adults undergoing congenital heart surgery in pediatric hospitals.

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Outcomes of Single-Ventricle Patients Supported With Extracorporeal Membrane Oxygenation*

Cited by 38 publications

References 21 publications

What is new in pediatric ECMO? 2016, a year in review

What is new in pediatric ECMO? 2016, a year in review

An overview of mechanical circulatory support in single-ventricle patients

Predictors of extracorporeal membrane oxygenation support after surgery for adult congenital heart disease in children's hospitals

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