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Eighteen years of paediatric extracorporeal membrane oxygenation and ventricular assist devices: insight regarding late outcomes

Published online by Cambridge University Press:  17 September 2018

Shawn M. Shah ,
David W. Kays ,
Sharon R. Ghazarian ,
Tom R. Karl ,
Plato Alexander ,
Nathaniel Sznycer-Taub ,
Jason Parker ,
Molly Oldeen ,
Melvin C. Almodovar  and
Gary Stapleton
...Show all authors
Shawn M. Shah
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
David W. Kays
Affiliation:
Department of Surgery, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
Sharon R. Ghazarian
Affiliation:
Health Informatics, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
Tom R. Karl
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Plato Alexander
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
Nathaniel Sznycer-Taub
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
Jason Parker
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
Molly Oldeen
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
Melvin C. Almodovar
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
Gary Stapleton
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
James A. Quintessenza
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA Department of Surgery, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA Health Informatics, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Alfred Asante-Korang
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
Vyas Kartha
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
Jade Hanson
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
Ernest Amankwah
Affiliation:
Health Informatics, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
Joeli Roth
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA
Jeffrey P. Jacobs*
Affiliation:
Divisions of Cardiovascular Surgery, Cardiology, Cardiac Critical Care, and Cardiac Anesthesia, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital, Saint Petersburg, Tampa and Orlando, FL, USA Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
*
Author for correspondence: J. P. Jacobs, MD, FACS, FACC, FCCP Professor of Surgery and Pediatrics, Johns Hopkins University, Deputy Director, Johns Hopkins All Children’s Heart Institute, Chief, Division of Cardiovascular Surgery, Director, Andrews/Daicoff Cardiovascular Program, and Surgical Director of Heart Transplantation, Johns Hopkins All Children’s Hospital, 601 Fifth Street South, Suite 607, Saint Petersburg, FL 33701, USA. Tel: +727 235 3100; Fax: +727 767 3704; E-mail: [email protected]; [email protected]
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Abstract

Background

We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality.

Methods

A retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan–Meier method.

Results

A total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan–Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan–Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%.

Conclusions

This single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan–Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.

Keywords

Mechanical circulatory supportextracorporeal membrane oxygenationECMOventricular assist deviceVAD
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 11 , November 2018 , pp. 1316 - 1322
Copyright
© Cambridge University Press 2018 

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