Author + information
- Marissa Brunettia,b,
- Lauren B. Retzloffa,b,
- Jessica L. Lehricha,b,
- J. William Gaynora,b,
- Sara Pasqualia,b,
- David Baillya,b,
- Susan Davisa,b,
- Darren Klugmana,b,
- Joshua Kocha,b,
- Javier Lasaa,b and
- Michael Gaiesa,b
Background: Extracorporeal Membrane Oxygenation (ECMO) is used to support pediatric patients with medical and surgical cardiac disease. We aimed to characterize ECMO use across a multicenter cohort.
Methods: Retrospective analysis of the Pediatric Cardiac Critical Care Consortium (PC4) clinical registry was performed to describe ECMO frequency and outcomes. Within strata of medical and surgical hospitalizations, we identified risk factors associated with ECMO use through multivariate logistic regression.
Results: Across 23 hospitals, there were 14,526 eligible hospitalizations from 8/1/14-6/30/16, of which 449 (3.1%) included at least 1 ECMO course. ECMO was used in 120 (2.4%) medical and 329 (3.5%) surgical hospitalizations. Low cardiac output was the most common ECMO indication in both groups. Extracorporeal cardiopulmonary resuscitation (E-CPR) was used in 42% of medical and 32% of surgical ECMO courses. Risk factors associated with ECMO use in the medical group included acute heart failure and higher vasoactive inotropic score at admission (both p<0.0001). Stroke (15%) and renal failure (15%) were the most common ECMO complications in the medical group. Risk factors associated with post-operative ECMO use in the surgical group included younger age, extra-cardiac anomalies, pre-operative morbidity, higher STAT category, bypass time, and early post-operative mechanical ventilation and arrhythmias (within 2 hours) (all p<0.05). Bleeding requiring re-operation (25%) was the most common ECMO complication in the surgical group. Hospital mortality was 63% in the medical group and 50% in the surgical group with E-CPR mortality rates of 83% and 50%, respectively.
Conclusions: This is the first multicenter study describing contemporary ECMO use and outcomes in pediatric CICU patients with all forms of cardiac disease. ECMO is a rare therapy, yet mortality remains high, highlighting the importance of identifying levers to improve care. We identified unique high-risk subgroups to target for quality initiatives within medical and surgical patients.
Room 146 C
Sunday, March 19, 2017, 8:38 a.m.-8:48 a.m.
Session Title: Highlighted Original Research: Congenital Heart Disease and the Year in Review
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 908-08
- 2017 American College of Cardiology Foundation