Author + information
- Laura Schoeneberg,
- Dean Merrill,
- Pratik Sandesara,
- Barbara Haney,
- Erica Molitor-Kirsch,
- James O'Brien Jr,
- Hongying Dai and
- Geetha Raghuveer
Optimal timing for discontinuation of Extra Corporeal Membrane Oxygenation (ECMO) in children with cardiac insufficiency unable to wean from ECMO is ill defined.
Outcomes following prolonged ECMO support (≥14 days) for cardiac insufficiency in children <18 years of age were examined.
We reviewed the International Extracorporeal Life Support Organization data from 1/1/2000-12/31/2011.
784 prolonged ECMO runs were identified, 177 (23%) survived to hospital discharge, survival decreased further when ECMO lasted ≥28 days (Fig). Compared to non-survivors, survivors were older (median 233vs.39 days, p<0.01), weighed more (16±20vs.8±13 kg, p<0.01), had shorter ECMO duration (20±6vs.22±9 days, p<0.01), and fewer organ complications (median 4vs.3, p<0.01). Those with congenital heart disease had lower survival compared to cardiomyopathy and myocarditis (15%vs.42&52%, p<0.01), single ventricle lesions had worse survival compared to double ventricle (10%vs.18%, p=0.01). 11% (n=89) received cardiac transplant and had better survival than those non-transplanted (53%vs.19%, p<0.01). Pre-ECMO arrest and emergent ECMO placement were not predictors of outcome.
Though 23% survived to hospital discharge, there is a significant attrition and morbidity following prolonged ECMO support for cardiac insufficiency in children. Cardiac transplantation in this cohort is also associated with high mortality. Earlier conversion to other modes of mechanical support as a bridge to transplant is recommended.
Oral Contributions North, Room 121
Saturday, March 09, 2013, 8:30 a.m.-8:45 a.m.
Session Title: Congenital Cardiology Solutions: Pediatric
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 904-5
- 2013 American College of Cardiology Foundation