Predictors and outcomes of early post-operative veno-arterial extracorporeal membrane oxygenation following infant cardiac surgery

Abstract

BackgroundWe aimed to determine predictors of, and outcomes after, veno-arterial extracorporeal membrane oxygenation instituted within 48 h after cardiac surgery (early ECMO) in young infants.MethodsPatients ≤ 6 weeks old having cardiac surgery from 2003 to 2012 were enrolled prospectively. Patients cannulated pre-operatively, intra-operatively, or ≥ 48 h post-operatively were excluded. Variables at p ≤ 0.1 on univariate regression were entered into multiple logistic regression to predict early ECMO. Early-ECMO cases were matched 1:2 for six demographic variables, and death by age 2 years old (determined using conditional logistic regression; presented as odds ratio (OR), 95% confidence interval (CI)) and General Adaptive Composite scores at age 2 years (determined using Wilcoxon rank sum) were compared; p ≤ 0.05 was considered statistically significant.ResultsOf 565 eligible patients over the 10-year period, 20 had early ECMO instituted at a mean (standard deviation) of 12.4 (11.4) h post-operatively, 10 of whom had extracorporeal cardiopulmonary resuscitation. Of early-ECMO patients, 8 (40%) were found to have residual anatomic defects requiring intervention with catheterization (n = 1) and/or surgery (n = 7). On multiple regression, the post-operative day 1 highest vasoactive-inotrope score (OR 1.02; 95%CI 1.06,1.08; p < 0.001), highest lactate (OR 1.2; 95%CI 1.06,1.35; p = 0.003), and lowest base deficit (OR 0.82; 95%CI 0.71,0.94; p = 0.004), CPB time (OR 1.01; 95%CI 1.00,1.02; p = 0.002), and single-ventricle anatomy (OR 5.35; 95%CI 1.66,17.31; p = 0.005) were associated with early ECMO. Outcomes at 2 years old compared between early-ECMO and matched patients were mortality 11/20 (55%) vs 11/40 (28%) (OR 3.22, 95%CI 0.98,10.63; p = 0.054) and General Adaptive Composite median 65 [interquartile range (IQR) 58, 81.5] in 9 survivors vs 93 [IQR 86.5, 102.5] in 29 survivors (p = 0.02).ConclusionsThe identified risk factors for, and outcomes after, having early ECMO may aid decision making in the acute period and confirm that neurodevelopmental follow-up for these children is necessary. The hypothesis that earlier institution of ECMO may improve long-term outcomes requires further study.

Outcomes of Preterm Infants With Congenital Heart Defects After Early Surgery: Defining Risk Factors at Different Time Points During Hospitalization

“…Consistent with previous reports ( 13 , 27 , 28 ), we have shown the primary cardiac defect of single ventricle and the peri-operative risk factor of CPR are important determinants of mortality. While GA and body weight did not predict death, the intra-uterine growth of the fetus as reflected by low birthweight z- scores was critical for this prediction.…”

Outcome of Cardiac ECMO in Children Less than 1 Year Age Undergoing Corrective Cardiac Surgery

“…13 A high-peak inotropic score predicted mechanical support in children requiring ECMO support, following fulminant myocarditis. 14,15 In our study, we found that while on ECMO, decreasing trend of vasoactive inotropic score over the first 5 days was associated with successful weaning and significantly improved survival on VA-ECMO (p value 0.003).…”

Postcardiotomy Extracorporeal Membrane Oxygenation in Neonates

“…If accompanied with serious complications, ECMO could not successfully wean off in shorand long-term assist devices, or switch to left ventricular assist device as bridge to heart transplantation should be considered. 16 In this group, there were eight patients with assist time of 1 to 3 days and five survived, nine patients assisted for 3 to 5 days and seven patients discharged; however, six patients assisted for more than 5 days and all died (p ¼ 0.01). Our results were close to the ELSO statistics, indicating that ECMO duration was one of the main factors affecting survival.…”