Risk factors for mortality in paediatric cardiac ICU patients managed with extracorporeal membrane oxygenation

Abstract

BackgroundVeno-arterial extracorporeal membrane oxygenation is frequently used in patients with cardiac disease. We evaluated short-term outcomes and identified factors associated with hospital mortality in cardiac patients supported with veno-arterial extracorporeal membrane oxygenation.MethodsA retrospective review of patients supported with veno-arterial extracorporeal membrane oxygenation at a university-affiliated children’s hospital was performed.ResultsA total of 253 patients with cardiac disease managed with extracorporeal membrane oxygenation were identified; survival to discharge was 48%, which significantly improved from 39% in an earlier era (1995–2001) (p=0.01). Patients were categorised into surgical versus non-surgical groups on the basis of whether they had undergone cardiac surgery before or not, respectively. The most common indication for extracorporeal membrane oxygenation was extracorporeal cardiopulmonary resuscitation: 96 (51%) in the surgical group and 45 (68%) in the non-surgical group. In a multiple covariate analysis, single-ventricle physiology (p=0.01), duration of extracorporeal membrane oxygenation (p<0.01), and length of hospital stay (p=0.03) were associated with hospital mortality. Weekend or night shift cannulation was associated with mortality in non-surgical patients (p=0.05).ConclusionWe report improvement in survival compared with an earlier era in cardiac patients supported with extracorporeal membrane oxygenation. Single-ventricle physiology continues to negatively impact survival, along with evidence of organ dysfunction during extracorporeal membrane oxygenation, duration of extracorporeal membrane oxygenation, and length of stay.

The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis

“…Twenty-six studies ( 2 , 10 – 34 ) were included in the analysis with a total of 186,648 patients, and the proportion of the population who underwent PC-ECMO was 2.5% (26 studies reporting on 2,683 patients) ( Table 1 ).…”

Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation

“…Dohain et al [ 17 ] reported a 40% survival rate with ECMO, and they declared that the survival rate was higher with biventricular repair. Single ventricular repair is declared as a risk factor for mortality [ 5 , 18 , 19 ] . Although in our study the survival rate with biventricular repair and single ventricular repair were 56.8% and 18.2%, respectively, it did not reach statistically significance ( P =0.055).…”

On-Hours Compared to Off-Hours Pediatric Extracorporeal Life Support Initiation in the United States Between 2009 and 2018—An Analysis of the Extracorporeal Life Support Organization Registry

“…Similar to our findings in pediatric patients, they did not observe any differences in mortality or complication rates between the groups. Achuff et al ( 12 ) described a 10-year experience from a single center ( n = 253), examining outcomes for neonatal and pediatric patients placed on ECLS in a cardiac ICU. In a subgroup of patients (those who had not undergone surgery prior to ECLS), they found increased mortality associated with initiation at night or on weekends.…”

“…In a subgroup of patients (those who had not undergone surgery prior to ECLS), they found increased mortality associated with initiation at night or on weekends. Over half of the patients in that study underwent eCPR ( 12 ). Burke et al ( 11 ) reported outcomes for 53 pediatric patients who underwent eCPR in a single center.…”

“…However, the multifactorial nature of eCPR confounds the attribution of these differences specifically to ECLS. Outside of eCPR, limited data from small studies of combined neonatal and pediatric populations have reported conflicting results on the impact of on-hours compared with off-hours ECLS cannulation on outcomes ( 12 , 13 ).…”