Outcomes after prolonged extracorporeal membrane oxygenation support in children with cardiac disease - Extracorporeal Life Support Organization registry study

Eric Dean Merrill, Laura Schoeneberg, Pratik Sandesara, Erica Molitor-Kirsch, James O'Brien, Hongying Dai, Geetha Raghuveer

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objective Extracorporeal membrane oxygenation remains the mainstay of mechanical circulatory support initiation and maintenance in children with cardiac insufficiency. However, the outcomes after prolonged extracorporeal membrane oxygenation for cardiac insufficiency in children remain ill defined. Methods We reviewed the International Extracorporeal Life Support Organization data from January 1, 2000, through December 31, 2011. We defined prolonged extracorporeal membrane oxygenation as uninterrupted support for ≥14 days. Results A total of 777 children aged <18 years required extracorporeal membrane oxygenation support for ≥14 days. Of these, 176 (23%) survived to hospital discharge. Compared with the nonsurvivors, the survivors were older (median age, 0.64 vs 0.10 years; P <.01), weighed more (median weight, 7.0 kg; range, 2-90; vs median, 4.0; range, 1.4-100 kg; P <.01), had a shorter duration of support (mean, 20 ± 6 vs 22 ± 9 days; P <.01), and a fewer number of organ system complications (mean, 2.8 ± 1.7 vs 3.6 ± 1.6, P <.01). Children with congenital heart disease had worse survival than those with cardiomyopathy and myocarditis (15% vs 42% and 52%, respectively; P <.01), and those with 1-ventricle physiology had worse survival than those with 2-ventricle physiology (10% vs 18%, P =.01). Seven percent (n = 56) reached cardiac transplantation, with 66% surviving to hospital discharge versus 19% of those not transplanted (P <.01). Conclusions The attrition is high after prolonged extracorporeal membrane oxygenation support for cardiac insufficiency in children. Cardiac transplantation in this cohort was rarely achieved and was associated with high mortality compared with benchmarks for cardiac transplantation survival. Earlier redirection of care or conversion to other modes of mechanical support as a bridge to transplantation should be considered.

Original languageEnglish (US)
Pages (from-to)582-588
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Extracorporeal Membrane Oxygenation
Registries
Heart Diseases
Heart Transplantation
Survival
Benchmarking
Myocarditis
Cardiomyopathies
Survivors
Transplantation
Maintenance
Organizations
Weights and Measures
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Outcomes after prolonged extracorporeal membrane oxygenation support in children with cardiac disease - Extracorporeal Life Support Organization registry study. / Merrill, Eric Dean; Schoeneberg, Laura; Sandesara, Pratik; Molitor-Kirsch, Erica; O'Brien, James; Dai, Hongying; Raghuveer, Geetha.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 2, 01.01.2014, p. 582-588.

Research output: Contribution to journalArticle

Merrill, Eric Dean ; Schoeneberg, Laura ; Sandesara, Pratik ; Molitor-Kirsch, Erica ; O'Brien, James ; Dai, Hongying ; Raghuveer, Geetha. / Outcomes after prolonged extracorporeal membrane oxygenation support in children with cardiac disease - Extracorporeal Life Support Organization registry study. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 148, No. 2. pp. 582-588.
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abstract = "Objective Extracorporeal membrane oxygenation remains the mainstay of mechanical circulatory support initiation and maintenance in children with cardiac insufficiency. However, the outcomes after prolonged extracorporeal membrane oxygenation for cardiac insufficiency in children remain ill defined. Methods We reviewed the International Extracorporeal Life Support Organization data from January 1, 2000, through December 31, 2011. We defined prolonged extracorporeal membrane oxygenation as uninterrupted support for ≥14 days. Results A total of 777 children aged <18 years required extracorporeal membrane oxygenation support for ≥14 days. Of these, 176 (23{\%}) survived to hospital discharge. Compared with the nonsurvivors, the survivors were older (median age, 0.64 vs 0.10 years; P <.01), weighed more (median weight, 7.0 kg; range, 2-90; vs median, 4.0; range, 1.4-100 kg; P <.01), had a shorter duration of support (mean, 20 ± 6 vs 22 ± 9 days; P <.01), and a fewer number of organ system complications (mean, 2.8 ± 1.7 vs 3.6 ± 1.6, P <.01). Children with congenital heart disease had worse survival than those with cardiomyopathy and myocarditis (15{\%} vs 42{\%} and 52{\%}, respectively; P <.01), and those with 1-ventricle physiology had worse survival than those with 2-ventricle physiology (10{\%} vs 18{\%}, P =.01). Seven percent (n = 56) reached cardiac transplantation, with 66{\%} surviving to hospital discharge versus 19{\%} of those not transplanted (P <.01). Conclusions The attrition is high after prolonged extracorporeal membrane oxygenation support for cardiac insufficiency in children. Cardiac transplantation in this cohort was rarely achieved and was associated with high mortality compared with benchmarks for cardiac transplantation survival. Earlier redirection of care or conversion to other modes of mechanical support as a bridge to transplantation should be considered.",
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AU - Merrill, Eric Dean

AU - Schoeneberg, Laura

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AU - Molitor-Kirsch, Erica

AU - O'Brien, James

AU - Dai, Hongying

AU - Raghuveer, Geetha

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N2 - Objective Extracorporeal membrane oxygenation remains the mainstay of mechanical circulatory support initiation and maintenance in children with cardiac insufficiency. However, the outcomes after prolonged extracorporeal membrane oxygenation for cardiac insufficiency in children remain ill defined. Methods We reviewed the International Extracorporeal Life Support Organization data from January 1, 2000, through December 31, 2011. We defined prolonged extracorporeal membrane oxygenation as uninterrupted support for ≥14 days. Results A total of 777 children aged <18 years required extracorporeal membrane oxygenation support for ≥14 days. Of these, 176 (23%) survived to hospital discharge. Compared with the nonsurvivors, the survivors were older (median age, 0.64 vs 0.10 years; P <.01), weighed more (median weight, 7.0 kg; range, 2-90; vs median, 4.0; range, 1.4-100 kg; P <.01), had a shorter duration of support (mean, 20 ± 6 vs 22 ± 9 days; P <.01), and a fewer number of organ system complications (mean, 2.8 ± 1.7 vs 3.6 ± 1.6, P <.01). Children with congenital heart disease had worse survival than those with cardiomyopathy and myocarditis (15% vs 42% and 52%, respectively; P <.01), and those with 1-ventricle physiology had worse survival than those with 2-ventricle physiology (10% vs 18%, P =.01). Seven percent (n = 56) reached cardiac transplantation, with 66% surviving to hospital discharge versus 19% of those not transplanted (P <.01). Conclusions The attrition is high after prolonged extracorporeal membrane oxygenation support for cardiac insufficiency in children. Cardiac transplantation in this cohort was rarely achieved and was associated with high mortality compared with benchmarks for cardiac transplantation survival. Earlier redirection of care or conversion to other modes of mechanical support as a bridge to transplantation should be considered.

AB - Objective Extracorporeal membrane oxygenation remains the mainstay of mechanical circulatory support initiation and maintenance in children with cardiac insufficiency. However, the outcomes after prolonged extracorporeal membrane oxygenation for cardiac insufficiency in children remain ill defined. Methods We reviewed the International Extracorporeal Life Support Organization data from January 1, 2000, through December 31, 2011. We defined prolonged extracorporeal membrane oxygenation as uninterrupted support for ≥14 days. Results A total of 777 children aged <18 years required extracorporeal membrane oxygenation support for ≥14 days. Of these, 176 (23%) survived to hospital discharge. Compared with the nonsurvivors, the survivors were older (median age, 0.64 vs 0.10 years; P <.01), weighed more (median weight, 7.0 kg; range, 2-90; vs median, 4.0; range, 1.4-100 kg; P <.01), had a shorter duration of support (mean, 20 ± 6 vs 22 ± 9 days; P <.01), and a fewer number of organ system complications (mean, 2.8 ± 1.7 vs 3.6 ± 1.6, P <.01). Children with congenital heart disease had worse survival than those with cardiomyopathy and myocarditis (15% vs 42% and 52%, respectively; P <.01), and those with 1-ventricle physiology had worse survival than those with 2-ventricle physiology (10% vs 18%, P =.01). Seven percent (n = 56) reached cardiac transplantation, with 66% surviving to hospital discharge versus 19% of those not transplanted (P <.01). Conclusions The attrition is high after prolonged extracorporeal membrane oxygenation support for cardiac insufficiency in children. Cardiac transplantation in this cohort was rarely achieved and was associated with high mortality compared with benchmarks for cardiac transplantation survival. Earlier redirection of care or conversion to other modes of mechanical support as a bridge to transplantation should be considered.

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