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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 June;81(6):619-27
Relationship of ECMO duration with outcomes after pediatric cardiac surgery: a multi-institutional analysis
Gupta P. 1, 2, Robertson M. J. 2, Beam B. 2, Gossett J. M. 3, Schmitz M. L. 4, Carroll C. L. 5, Edwards J. D. 6, Fortenberry J. D. 7, Butt W. 8 ✉
1 Division of Pediatric Critical Care, Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA;
2 Division of Pediatric Cardiology, Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA;
3 Section of Biostatistics, Department of Pediatrics, Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA;
4 Division of Pediatric Anesthesia, Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA;
5 Division of Pediatric Critical Care, Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, USA;
6 Division of Pediatric Critical Care, Columbia University College of Physician and Surgeons, NY, USA;
7 Division of Pediatric Critical Care Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA;
8 Department of Pediatric Intensive Care, The Royal Children’s Hospital, Melbourne, Australia
BACKGROUND: There are very sparse data on the outcomes of children receiving prolonged extracorporeal membrane oxygenation (ECMO) after cardiac surgery. This study was aimed to evaluate the association of ECMO duration with outcomes in children undergoing surgery for congenital heart disease using the Pediatric Health Information System (PHIS) database.
METHODS: Patients aged ≤18 years receiving ECMO after pediatric cardiac surgery (with or without cardiopulmonary bypass) at a PHIS-participating hospital (2004-2013) were included. De-identified data obtained from retrospective, observational dataset included demographic information, baseline characteristics, pre-ECMO risk factors, operation details, patient diagnoses, and center data. Outcomes evaluated included in-hospital mortality, length of mechanical ventilation, length of ICU stay, length of hospital stay, and hospital charges. Cox proportional hazards models were fitted to study the probability of study outcomes as a function of ECMO duration.
RESULTS: Nine hundred ninety-eight patients from 37 hospitals qualified for inclusion. The median duration of ECMO run was 4 days (IQR: 1.7). After adjusting for patient and center characteristics, there was 12% increase in the odds of mortality for every 24 hours increase in ECMO duration (OR: 1.12, 95% CI: 1.07-1.18, P<0.001). Patients receiving longer duration of ECMO were associated with longer length of mechanical ventilation, longer length of ICU stay, longer length of hospital stay, and higher hospital charges.
CONCLUSION: Data from this large multicenter database suggest that longer duration of ECMO support after pediatric cardiac surgery is associated with worsening outcomes.