Titus Chan1, Ravi R Thiagarajan, Deborah Frank, Susan L Bratton. 1. Department of Pediatrics, Division of Pediatric Critical Care, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84158-1289, USA. tituschan@gmail.com).
Abstract
OBJECTIVE: We investigated survival and predictors of mortality for infants and children with heart disease treated with extracorporeal membrane oxygenation as an aid to cardiopulmonary resuscitation. METHODS: Children (<18 years) with heart disease who received extracorporeal cardiopulmonary resuscitation and were reported to the Extracorporeal Life Support Organization database were evaluated. Patients were classified into one of 3 groups based on underlying cardiac physiology: single ventricle, 2 ventricles, and cardiac muscle disease. Patients with eligible procedure codes were assigned a Risk Adjustment for Congenital Heart Surgery-1 classification. RESULTS: Four hundred ninety-two patients were eligible for analysis, and 279 (57%) were assigned a Risk Adjustment for Congenital Heart Surgery-1 category. Overall survival was 42%. In a multivariable logistic regression analysis, significant pre-extracorporeal predictors for mortality included single-ventricle physiology (odds ratio, 1.6; 95% confidence interval, 1.05-2.4), a history of a stage 1-type procedure (odds ratio, 2.7; 95% confidence interval, 1.2-6.2), and extreme acidosis (arterial blood gas pH < 7.01; odds ratio, 2.2; 95% confidence interval, 1.3-3.7). Right carotid artery cannulation was associated with decreased mortality risk (odds ratio, 0.6; 95% confidence interval, 0.4-0.9). During extracorporeal support, complications, including renal injury, evidence of neurologic injury, and persistent acidosis, were associated with an increased risk of hospital mortality. CONCLUSION: Use of extracorporeal membrane oxygenation as an adjunct to cardiopulmonary resuscitation resulted in hospital survival in 42% of infants and children with heart disease. Underlying cardiac physiology and associated cardiac surgical procedures influenced mortality, as did pre-extracorporeal resuscitation status and extracorporeal membrane oxygenation-associated complications.
OBJECTIVE: We investigated survival and predictors of mortality for infants and children with heart disease treated with extracorporeal membrane oxygenation as an aid to cardiopulmonary resuscitation. METHODS:Children (<18 years) with heart disease who received extracorporeal cardiopulmonary resuscitation and were reported to the Extracorporeal Life Support Organization database were evaluated. Patients were classified into one of 3 groups based on underlying cardiac physiology: single ventricle, 2 ventricles, and cardiac muscle disease. Patients with eligible procedure codes were assigned a Risk Adjustment for Congenital Heart Surgery-1 classification. RESULTS: Four hundred ninety-two patients were eligible for analysis, and 279 (57%) were assigned a Risk Adjustment for Congenital Heart Surgery-1 category. Overall survival was 42%. In a multivariable logistic regression analysis, significant pre-extracorporeal predictors for mortality included single-ventricle physiology (odds ratio, 1.6; 95% confidence interval, 1.05-2.4), a history of a stage 1-type procedure (odds ratio, 2.7; 95% confidence interval, 1.2-6.2), and extreme acidosis (arterial blood gas pH < 7.01; odds ratio, 2.2; 95% confidence interval, 1.3-3.7). Right carotid artery cannulation was associated with decreased mortality risk (odds ratio, 0.6; 95% confidence interval, 0.4-0.9). During extracorporeal support, complications, including renal injury, evidence of neurologic injury, and persistent acidosis, were associated with an increased risk of hospital mortality. CONCLUSION: Use of extracorporeal membrane oxygenation as an adjunct to cardiopulmonary resuscitation resulted in hospital survival in 42% of infants and children with heart disease. Underlying cardiac physiology and associated cardiac surgical procedures influenced mortality, as did pre-extracorporeal resuscitation status and extracorporeal membrane oxygenation-associated complications.
Authors: Monica E Kleinman; Allan R de Caen; Leon Chameides; Dianne L Atkins; Robert A Berg; Marc D Berg; Farhan Bhanji; Dominique Biarent; Robert Bingham; Ashraf H Coovadia; Mary Fran Hazinski; Robert W Hickey; Vinay M Nadkarni; Amelia G Reis; Antonio Rodriguez-Nunez; James Tibballs; Arno L Zaritsky; David Zideman Journal: Circulation Date: 2010-10-19 Impact factor: 29.690
Authors: Monica E Kleinman; Allan R de Caen; Leon Chameides; Dianne L Atkins; Robert A Berg; Marc D Berg; Farhan Bhanji; Dominique Biarent; Robert Bingham; Ashraf H Coovadia; Mary Fran Hazinski; Robert W Hickey; Vinay M Nadkarni; Amelia G Reis; Antonio Rodriguez-Nunez; James Tibballs; Arno L Zaritsky; David Zideman Journal: Pediatrics Date: 2010-10-18 Impact factor: 7.124
Authors: Adrian C Mattke; Christian F Stocker; Andreas Schibler; Nelson Alphonso; Kerry Johnson; Tom R Karl Journal: Intensive Care Med Date: 2015-09-10 Impact factor: 17.440
Authors: Javier J Lasa; Parag Jain; Tia T Raymond; Charles G Minard; Alexis Topjian; Vinay Nadkarni; Michael Gaies; Melania Bembea; Paul A Checchia; Lara S Shekerdemian; Ravi Thiagarajan Journal: Pediatr Crit Care Med Date: 2018-02 Impact factor: 3.624
Authors: Satish K Rajagopal; Christopher S Almond; Peter C Laussen; Peter T Rycus; David Wypij; Ravi R Thiagarajan Journal: Crit Care Med Date: 2010-02 Impact factor: 7.598
Authors: Parthak Prodhan; Richard T Fiser; Umesh Dyamenahalli; Jeffrey Gossett; Michiaki Imamura; Robert D B Jaquiss; Adnan T Bhutta Journal: Resuscitation Date: 2009-08-19 Impact factor: 5.262