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Extended survival and re-hospitalisation among paediatric patients requiring extracorporeal membrane oxygenation for primary cardiac dysfunction

Published online by Cambridge University Press:  14 June 2012

Nicole Erwin ,
Jeannie Zuk ,
Jon Kaufman ,
Zhaoxing Pan ,
Esther Carpenter ,
Max B. Mitchell  and
Eduardo M. da Cruz
Nicole Erwin
Affiliation:
School of Medicine, Anschutz Medical Campus, The University of Colorado, Colorado, United States of America
Jeannie Zuk
Affiliation:
Department of Anesthesiology, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America
Jon Kaufman
Affiliation:
Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America
Zhaoxing Pan
Affiliation:
The Research Institute, University of Colorado, Colorado, United States of America
Esther Carpenter
Affiliation:
Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America
Max B. Mitchell
Affiliation:
Pediatric Cardiac Surgery, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America
Eduardo M. da Cruz*
Affiliation:
Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America
*
Correspondence to: Dr E. M. da Cruz, MD, Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, School of Medicine, University of Colorado at Denver, 13120 East 16th Avenue, B-100, Aurora, Colorado 80045, United States of America. Tel: +1 720 777 4055; Fax: +1 720 777 7290; E-mail: eduardo.dacruz@childrenscolorado.org
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Abstract

Background

Although survival to hospital discharge among children requiring extracorporeal membrane oxygenation support for medical and surgical cardio-circulatory failure has been reported in international registries, extended survival and re-hospitalisation rates have not been well described in the literature.

Material and methods

This is a single-institution, retrospective review of all paediatric patients receiving extracorporeal membrane oxygenation for primary cardiac dysfunction over a 5-year period.

Results

A total of 74 extracorporeal membrane oxygenation runs in 68 patients were identified, with a median follow-up of 5.4 years from hospital discharge. Overall, 66% of patients were decannulated alive and 25 patients (37%) survived to discharge. There were three late deaths at 5 months, 20 months, and 6.8 years from discharge. Of the hospital survivors, 88% required re-hospitalisation, with 63% of re-admissions for cardiac indications. The median number of hospitalisations per patient per year was 0.62, with the first re-admission occurring at a mean time of 9 months after discharge from the index hospitalisation. In all, 38% of patients required further cardiac surgery.

Conclusions

Extended survival rates for paediatric hospital survivors of cardiac extracorporeal membrane oxygenation support for medical and post-surgical indications are encouraging. However, re-hospitalisation within the first year following hospital discharge is common, and many patients require further cardiac surgery. Although re-admission hospital mortality is low, longer-term follow-up of quality-of-life indicators is required.

Keywords

Paediatric cardiac surgerymechanical assistanceoutcomesre-admissions
Type
Original Article
Information
Cardiology in the Young , Volume 23 , Issue 2 , April 2013 , pp. 258 - 264
Copyright
Copyright © Cambridge University Press 2012 

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References

1. Bartlett, RH, Roloff, DW, Custer, JR, Younger, JG, Hirschl, RB. Extracorporeal life support: the University of Michigan experience. JAMA 2000; 283: 904–908.CrossRefGoogle ScholarPubMed
2. Aharon, AS, Drinkwater, DC Jr, Churchwell, KB, et al. Extracorporeal membrane oxygenation in children after repair of congenital cardiac lesions. Ann Thorac Surg 2001; 72: 2095–2102.CrossRefGoogle ScholarPubMed
3. Baslaim, G, Bashore, J, Al-Malki, F, Jamjoom, A. Can the outcome of pediatric extracorporeal membrane oxygenation after cardiac surgery be predicted? Ann Thorac Surg 2006; 12: 21–27.Google Scholar
4. Ghez, O, Feier, H, Ughetto, F, Fraisse, A, Kreitmann, B, Metras, D. Postoperative extracorporeal life support in pediatric cardiac surgery: recent results. ASAIO J 2005; 51: 513–516.Google Scholar
5. Huang, SC, Wu, ET, Chen, YS, et al. Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Crit Care Med 2008; 36: 1607–1613.CrossRefGoogle ScholarPubMed
6. Undar, A, McKenzie, ED, McGarry, MC, et al. Outcomes of congenital heart surgery patients after extracorporeal life support at Texas Children's Hospital. Artif Organs 2004; 28: 963–966.Google Scholar
7. Duncan, BW, Ibrahim, AE, Hraska, V, et al. Use of rapid-deployment extracorporeal membrane oxygenation for the resuscitation of pediatric patients with heart disease after cardiac arrest. J Thorac Cardiovasc Surg 1998; 116: 305–311.Google Scholar
8. da Cruz, EM, Beghetti, M, Kalangos, A, et al. Mechanical support availability in pediatric cardiac surgery: program size should not matter. Int J Cardiol 2008; 129: 282–284.Google Scholar
9. Bohn, D. ECMO – long term follow up. Paediatr Respir Rev 2006; 7 (Suppl. 1): S194–S195.Google Scholar
10. UK Collaborative ECMO Group. The collaborative UK ECMO trial: follow-up to 1 year of age. Pediatrics 1998; 101: e1–e10.CrossRefGoogle Scholar
11. Boykin, AR, Quivers, ES, Wagenhoffer, KL, et al. Cardiopulmonary outcome of neonatal extracorporeal membrane oxygenation at ages 10–15 years. Crit Care Med 2003; 31: 2380–2384.Google Scholar
12. Glass, P, Wagner, AE, Papero, PH, et al. Neurodevelopmental status at age five years of neonates treated with extracorporeal membrane oxygenation. J Pediatr 1995; 127: 447–457.Google Scholar
13. Nield, TA, Langenbacher, D, Poulsen, MK, Platzker, AC. Neurodevelopmental outcome at 3.5 years of age in children treated with extracorporeal life support: relationship to primary diagnosis. J Pediatr 2000; 136: 338–344.CrossRefGoogle ScholarPubMed
14. Schumacher, RE, Palmer, TW, Roloff, DW, LaClaire, PA, Bartlett, RH. Follow-up of infants treated with extracorporeal membrane oxygenation for newborn respiratory failure. Pediatrics 1991; 87: 451–457.Google Scholar
15. Schoeman, L, Pierro, A, Macrae, D, Spitz, L, Kiely, EM, Drake, DP. Late death after extracorporeal membrane oxygenation for congenital diaphragmatic hernia. J Pediatr Surg 1999; 34: 357–359.CrossRefGoogle ScholarPubMed
16. Ibrahim, AE, Duncan, BW, Blume, ED, Jonas, RA. Long-term follow-up of pediatric cardiac patients requiring mechanical circulatory support. Ann Thorac Surg 2000; 69: 186–192.Google Scholar
17. Fenton, KN, Webber, SA, Danford, DA, et al. Long-term survival after pediatric cardiac transplantation and postoperative ECMO support. Ann Thorac Surg 2003; 76: 843–847.Google Scholar
18. Jen, HC, Shew, SB. Hospital readmissions and survival after nonneonatal pediatric ECMO. Pediatrics 2010; 125: 1217–1223.CrossRefGoogle ScholarPubMed
19. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911–924.Google Scholar
20. Lequier, L. Extracorporeal life support in pediatric and neonatal critical care: a review. J Intensive Care Med 2004; 19: 243–258.CrossRefGoogle ScholarPubMed
21. Mackie, AS, Ionescu-Ittu, R, Pilote, L, Rahme, E, Marelli, AJ. Hospital readmissions in children with congenital heart disease: a population-based study. Am Heart J 2008; 155: 577–584.Google Scholar
22. Radford, DJ, Lachman, R, Thong, YH. The immunocompetence of children with congenital heart disease. Int Arch Allergy Appl Immunol 1986; 81: 331–336.Google Scholar
23. Jaggers, JJ, Forbess, JM, Shah, AS, et al. Extracorporeal membrane oxygenation for infant postcardiotomy support: significance of shunt management. Ann Thorac Surg 2000; 69: 1476–1483.Google Scholar
24. Reinhartz, O, Stiller, B, Eilers, R, Farrar, DJ. Current clinical status of pulsatile pediatric circulatory support. ASAIO J 2002; 48: 455–459.Google Scholar
25. Kolovos, NS, Bratton, SL, Moler, FW, et al. Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery. Ann Thorac Surg 2003; 76: 1435–1442.Google Scholar
26. Huang, SC, Wu, ET, Chen, YS, et al. Experience with extracorporeal life support in pediatric patients after cardiac surgery. ASAIO J 2005; 51: 517–521.Google Scholar
27. Taylor, AK, Cousins, R, Butt, WW. The long term outcome of children managed with extracorporeal life support: an intuitional experience. Crit Care Resusc 2007; 9: 172–177.Google Scholar
28. Tissot, C, Buckvold, S, Phelps, CM, et al. Outcome of extracorporeal membrane oxygenation for early primary graft failure after pediatric heart transplantation. J Am Coll Cardiol 2009; 54: 730–737.Google Scholar
29. Mitchell, MB, Campbell, DN, Bielefeld, MR, Doremus, T. Utility of extracorporeal membrane oxygenation for early graft failure following heart transplantation in infancy. J Heart Lung Transplant 2000; 19: 834–839.Google Scholar
30. Fisher, JC, Stolar, CJ, Cowles, RA. Extracorporeal membrane oxygenation for cardiopulmonary failure in pediatric patients: is a second course justified? J Surg Res 2008; 148: 100–108.Google Scholar
31. Shuhaiber, J, Thiagarajan, RR, Laussen, PC, Fynn-Thompson, F, Del Nido, P, Pigula, F. Survival of children requiring repeat extracorporeal membrane oxygenation after congenital heart surgery. Ann Thorac Surg 2011; 91: 1949–1955.Google Scholar