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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: oconnorm@email.chop.edu
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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 

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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

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