Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-26T06:19:09.758Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  31 October 2018

Barbara-Jo Achuff ,
Matthew D. Elias ,
Richard F. Ittenbach ,
Chitra Ravishankar ,
Susan C. Nicolson ,
Thomas L. Spray ,
Stephanie Fuller ,
J. William Gaynor  and
Matthew J. O’Connor
Barbara-Jo Achuff
Affiliation:
Division of Critical Care, Texas Children’s Hospital, Houston, TX, USA
Matthew D. Elias
Affiliation:
Divisions of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Richard F. Ittenbach
Affiliation:
Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital, Cincinnati, OH, USA
Chitra Ravishankar
Affiliation:
Divisions of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Susan C. Nicolson
Affiliation:
Cardiothoracic Anesthesiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Thomas L. Spray
Affiliation:
Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Stephanie Fuller
Affiliation:
Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
J. William Gaynor
Affiliation:
Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Matthew J. O’Connor*
Affiliation:
Divisions of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Author for correspondence: Matthew J. O’Connor, MD, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA. Tel: +1 267 426 2882; Fax: +1 267 426 9800; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Veno-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.

Methods

A retrospective review of patients supported with veno-arterial extracorporeal membrane oxygenation at a university-affiliated children’s hospital was performed.

Results

A 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).

Conclusion

We 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.

Keywords

Paediatricextracorporeal membrane oxygenationCHDmortalitycardiac intensive care
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 1 , January 2019 , pp. 40 - 47
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Achuff B-J, Elias MD, Ittenbach RF, Ravishankar C, Nicolson SC, Spray TL, Fuller S, Gaynor JW, O’Connor MJ. (2018) Risk factors for mortality in paediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation. Cardiology in the Young29: 40–47. doi: 10.1017/S1047951118001774

References

1. Punn, R, Axelrod, DM, Sherman-Levine, S, et al. Predictors of mortality in pediatric patients on venoarterial extracorporeal membrane oxygenation. Pediatr Crit Care Med 2014; 15: 870–877.Google Scholar
2. Kumar, TK, Zurakowski, D, Dalton, H, et al. Extracorporeal membrane oxygenation in post cardiotomy patients: factors influencing outcome. J Thorac Cardiovasc Surg 2010; 140: 330–336.Google Scholar
3. Chrysostomou, C, Morell, VO, Kuch, BA, et al. Short and intermediate-term survival after extracorporeal membrane oxygenation in children with cardiac disease. J Thorac Cardiovasc Surg 2013; 146: 317–325.Google Scholar
4. Bairdain, S, Betit, P, Craig, N, et al. Diverse morbidity and mortality among infants treated with venoarterial extracorporeal membrane oxygenation. Cureus 2015; 7: e263.Google Scholar
5. Mehta, NM, Turner, D, Walsh, B, et al. Factors associated with survival in pediatric extracorporeal membrane oxygenation: a single-center experience. J Pediatr Surg 2010; 45: 1995–2003.Google Scholar
6. Delmo Walter, EM, Alexi-Meskishvili, V, et al. Extracorporeal membrane oxygenation for intraoperative cardiac support in children with congenital heart disease. Cardiovasc Thorac Surg 2010; 10: 753–758.Google Scholar
7. Morris, MC, Ittenbach, RF, Godinez, RI, et al. Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation. Crit Care Med 2004; 32: 1061–1069.Google Scholar
8. Elias, MD, Achuff, BJ, Ittenbach, RF, et al. Long-term outcomes of pediatric cardiac patients supported by extracorporeal membrane oxygenation. Pediatr Crit Care Med 2017; 18: 787–794.Google Scholar
9. Clancy, RR, McGaurn, SA, Wernovsky, G, et al. Pre-operative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate. J Thorac Cardiovasc Surg 2000; 119: 347–357.Google Scholar
10. Chauhan, S, Malik, M, Malik, V, et al. Extracorporeal membrane oxygenation after pediatric cardiac surgery: a 10-year experience. Ann Card Anaesth 2011; 14: 19–24.Google Scholar
11. Mascio, CE, Austin, EH 3rd, Jacobs, JP, et al. Perioperative mechanical circulatory support in children: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2014; 147: 658–664.Google Scholar
12. Ravishankar, C, Dominguez, TE, Kreutzer, J, et al. Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome. Pediatr Crit Care Med 2006; 7: 319–323.Google Scholar
13. Tabbutt, S, Ghanayem, N, Ravishankar, C, et al. Risk factors for hospital morbidity and mortality after the Norwood procedure: a report from the Pediatric Heart Network Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 2012; 144: 882–895.Google Scholar
14. Brogan, TV, Zabrocki, L, Thiagarajan, RR, et al. Prolonged extracorporeal membrane oxygenation for children with respiratory failure. Pediatr Crit Care Med 2012; 13: e249–e254.Google Scholar
15. Ricci, Z, Haiberger, R, Pezzella, C, et al. Evaluation of endotoxemia after pediatric cardiac surgery with the endotoxin activity assay: an exploratory prospective cohort study. Pediatr Crit Care Med 2016; 17: e76–e80.Google Scholar
16. Gupta, P, Robertson, MJ, Rettiganti, M, et al. Impact of timing of extracorporeal membrane oxygenation initiation on outcomes after pediatric heart surgery: a multi-institutional analysis. Pediatr Cardiol. 2016; 37: 971–978.Google Scholar
17. Omar, HR, Mirsaeidi, M, Mangar, D, et al. Duration of extracorporeal membrane oxygenation is an independent predictor of intracranial hemorrhage occurring during extracorporeal membrane oxygenation support. ASAIO J 2016; 62: 634–636.Google Scholar
18. Smith, AH, Hardison, DC, Worden, CR, et al. Acute renal failure during extracorporeal support in the pediatric cardiac patient. ASAIO J 2009; 55: 412–416.Google Scholar
19. Harris, SK, Lewington, AJ, Harrison, DA, et al. Relationship between patients’ outcomes and the changes in serum creatinine and urine output and RIFLE classification in a large critical care cohort database. Kidney Int 2015; 88: 369–377.Google Scholar
20. Granger, DN, Kvietys, PR. Reperfusion injury and reactive oxygen species: the evolution of a concept. Redox biology 2015; 6: 524–551.Google Scholar
21. Graulich, J, Walzog, B, Marcinkowski, M, et al. Leukocyte and endothelial activation in a laboratory model of extracorporeal membrane oxygenation. Pediatr Res 2000; 48: 679–684.Google Scholar
22. Roth, C, Schrutka, L, Binder, C, et al. Liver function predicts survival in patients undergoing extracorporeal membrane oxygenation following cardiovascular surgery. Crit Care 2016; 20: 57.Google Scholar
23. Patroniti, N, Sangalli, F, Avalli, L. Post-cardiac arrest extracorporeal life support. Best Pract Res Clin Anaesthesiol 2015; 29: 497–508.Google Scholar
24. Lasa, JJ, Rogers, RS, Localio, R, et al. Extracorporeal cardiopulmonary resuscitation during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge: a report from the American Heart Association’s Get with the Guidelines-Resuscitation (GWTG-R) registry. Circulation 2016; 133: 165–176.Google Scholar
25. Kane, DA, Thiagarajan, RR, Wypij, D, et al. Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 2010; 122: S241–S248.Google Scholar
26. Lee, DS, Chung, CR, Jeon, K, et al. Survival after extracorporeal cardiopulmonary resuscitation on weekends in comparison with weekdays. Ann Thorac Surg 2016; 101: 133–140.Google Scholar
27. Duncan, BW, Hraska, V, Jonas, RA, et al. Mechanical circulatory support in children with cardiac disease. J Thorac Cardiovasc Surg 1999; 117: 529–542.Google Scholar
28. Clark, JB, Pauliks, LB, Myers, JL, et al. Mechanical circulatory support for end-stage heart failure in repaired and palliated congenital heart disease. Curr Cardiol Rev 2011; 7: 102–109.Google Scholar