Author + information
- David J. Goldberg,
- Chitra Ravishankar,
- Roxanne E. Kirsch,
- Maryam Y. Naim,
- Antonio R. Mott and
- Joseph W. Rossano
Extracorporeal membrane oxygenation (ECMO) is increasingly used in children with single ventricle (SV) anomalies. Our objective is to describe the outcomes and risk factors for mortality in this high-risk group.
We retrospectively analyzed the Kids’ Inpatient Database (KID) for ECMO use in children ≤ 18 years with SV anomalies for 2000, 2003, 2006, and 2009. The KID is a nationwide sampling of pediatric hospitalizations and is weighted to provide national estimates.
751 children (95% CI 559-943) with SV were supported with ECMO in the four years reported, 87% were infants. Overall mortality was 57% and did not improve over time (2000=52%, 2003=63%, 2006=57%, 2009=55%, p=.66). Compared to children with SV who were not supported with ECMO, those who were supported were more likely to have undergone a cardiac procedure (46% vs. 90%, p<.001) or have an associated diagnosis of arrhythmia (13% vs. 22%, p<.001), cerebrovascular disease (1% vs. 9%, p<.001), heart failure (12% vs. 24%, p<.001), hepatic insufficiency (1% vs. 3%, p<.001), acute renal failure (3% vs. 28%, p<.001), or sepsis (8% vs. 28%, p<.001). For those supported with ECMO, risk factors for mortality by univariate analysis included an associated diagnosis of hepatic insufficiency (mortality 87%, odds ratio 5.2, p=.03) or acute renal failure (mortality 76%, odds ratio 3.3, p<.001). By multivariate analysis only acute renal failure remained as a significant risk factor (odds ratio 3.0, p<.001).
In the four years reported, 43% of children with SV who required ECMO survived although survival did not improve over time. Arrhythmias, heart failure, infection, and end organ dysfunction were more common in SV patients supported with ECMO than those who were not. Acute renal failure was an independent risk factor for mortality. Further studies are needed to identify patients who are most likely to benefit from ECMO support.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Congenital Cardiology Solutions: Surgical Outcomes
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1118-123
- 2013 American College of Cardiology Foundation