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

Abstract

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.

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

“…Eight studies reported improved survival in patients with private relative to government insurance (28, 77, 88, 89, 106, 123, 128, 129). Eight found no survival difference (55, 65, 81, 92, 130–133), with variable cost, complication, readmission, and LOS results (31, 33, 56, 70, 125, 126, 128, 134), including one with higher renal replacement in privately insured patients (83).…”

“…Of 17 studies examining insurance status, one from South Korea showed higher ECMO use in patients with NHI versus “medical aid” (164). Of 16 U.S. studies, four found no difference (31, 139, 159, 165), 10 showed greater use in patients with private insurance (vs government insurance) (28, 89, 129, 132, 137, 148, 154, 160, 166) or any insurance (vs uninsured) (167). One obstetric study observed higher ECMO use with government insurance (155), and another showed lower ECMO use in insured patients with COVID-19 (138).…”

Venopulmonary ECMO Improved Hypoxemia and Supported the Right Ventricle in a Patient with Decompensated Eisenmenger Syndrome

“…In parallel with survivorship, the complexity of ACHD has increased substantially over the past two decades, and there is an increased need for options of respiratory (venovenous (VV) ECMO) and/or mechanical circulatory support (venoarterial (VA) ECMO) [2]. ACHD patients often have a complex anatomy and may have undergone multiple prior interventions, resulting in limitations to vascular access [3]. Because of its special configuration, venopulmonary artery (VPA) ECMO (Figure 1) appears to be an attractive option in patients with ACHD.…”