OBJECTIVE: To report the outcomes from a large multicenter cohort of neonates requiring extracorporeal membrane oxygenation (ECMO) after stage 1 palliation for hypoplastic left heart syndrome. METHODS: Using data from the Extracorporeal Life Support Organization (2000-2009), we computed the survival to hospital discharge for neonates (age ≤30 days) supported with ECMO after stage 1 palliation for hypoplastic left heart syndrome. The factors associated with mortality were evaluated using multivariate logistic regression analysis. RESULTS: Among 738 neonates, the survival rate was 31%. The median age at cannulation was 7 days (interquartile range, 4-11). Black race (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2-3.6), mechanical ventilation before ECMO (>15-131 hours: OR, 1.6; 95% CI, 1.1-2.4; >131 hours: OR, 1.9; 95% CI, 1.3-2.9), use of positive end expiratory pressure (>6-8 cm H(2)O: OR, 1.7; 95% CI, 1.1-2.7; >8 cm H(2)O: OR, 1.9; 95% CI, 1.2-3.1), and longer ECMO duration (per day, OR, 1.2; 95% CI, 1.1-1.3) increased mortality. ECMO support for failure to wean from cardiopulmonary bypass (OR, 1.6; 95% CI, 1.02-2.4) also decreased survival. ECMO complications, including renal failure (OR, 1.9; 95% CI, 1.2-3.1), inotrope requirement (OR, 1.5; 95% CI, 1.1-2.1), myocardial stun (OR, 3.2; 95% CI, 1.3-7.7), metabolic acidosis (OR, 2.9; 95% CI, 1.3-6.7), and neurologic injury (OR, 1.7; 95% CI, 1.1-2.6), during support also increased mortality. CONCLUSIONS: Mortality for neonates with hypoplastic left heart syndrome supported with ECMO after stage 1 palliation is high. Longer ventilation before cannulation, longer support duration, and ECMO complications increased mortality.
OBJECTIVE: To report the outcomes from a large multicenter cohort of neonates requiring extracorporeal membrane oxygenation (ECMO) after stage 1 palliation for hypoplastic left heart syndrome. METHODS: Using data from the Extracorporeal Life Support Organization (2000-2009), we computed the survival to hospital discharge for neonates (age ≤30 days) supported with ECMO after stage 1 palliation for hypoplastic left heart syndrome. The factors associated with mortality were evaluated using multivariate logistic regression analysis. RESULTS: Among 738 neonates, the survival rate was 31%. The median age at cannulation was 7 days (interquartile range, 4-11). Black race (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2-3.6), mechanical ventilation before ECMO (>15-131 hours: OR, 1.6; 95% CI, 1.1-2.4; >131 hours: OR, 1.9; 95% CI, 1.3-2.9), use of positive end expiratory pressure (>6-8 cm H(2)O: OR, 1.7; 95% CI, 1.1-2.7; >8 cm H(2)O: OR, 1.9; 95% CI, 1.2-3.1), and longer ECMO duration (per day, OR, 1.2; 95% CI, 1.1-1.3) increased mortality. ECMO support for failure to wean from cardiopulmonary bypass (OR, 1.6; 95% CI, 1.02-2.4) also decreased survival. ECMO complications, including renal failure (OR, 1.9; 95% CI, 1.2-3.1), inotrope requirement (OR, 1.5; 95% CI, 1.1-2.1), myocardial stun (OR, 3.2; 95% CI, 1.3-7.7), metabolic acidosis (OR, 2.9; 95% CI, 1.3-6.7), and neurologic injury (OR, 1.7; 95% CI, 1.1-2.6), during support also increased mortality. CONCLUSIONS: Mortality for neonates with hypoplastic left heart syndrome supported with ECMO after stage 1 palliation is high. Longer ventilation before cannulation, longer support duration, and ECMO complications increased mortality.
Authors: Jaclyn A Gellings; William K Johnson; Nancy S Ghanayem; Michael Mitchell; James Tweddell; George Hoffman; Viktor Hraska; Evelyn M Kuhn; Ronald K Woods Journal: Semin Thorac Cardiovasc Surg Date: 2019-08-09
Authors: Emilie Jean-St-Michel; Devin Chetan; Steven M Schwartz; Glen S Van Arsdell; Alejandro A Floh; Osami Honjo; Jennifer Conway Journal: Pediatr Cardiol Date: 2015-09-22 Impact factor: 1.655
Authors: Titus Chan; Jane Di Gennaro; Reid W D Farris; Monique Radman; David Michael McMullan Journal: Crit Care Med Date: 2017-04 Impact factor: 7.598
Authors: Ryan P Barbaro; Folafoluwa O Odetola; Kelley M Kidwell; Matthew L Paden; Robert H Bartlett; Matthew M Davis; Gail M Annich Journal: Am J Respir Crit Care Med Date: 2015-04-15 Impact factor: 21.405
Authors: Richard P Fernandez; Brian F Joy; Robin Allen; Jamie Stewart; Holly Miller-Tate; Yongjie Miao; Lisa Nicholson; Clifford L Cua Journal: Pediatr Cardiol Date: 2016-11-01 Impact factor: 1.655
Authors: Colleen M O'Kelly Priddy; Masaki Kajimoto; Dolena R Ledee; Bertrand Bouchard; Nancy Isern; Aaron K Olson; Christine Des Rosiers; Michael A Portman Journal: Am J Physiol Heart Circ Physiol Date: 2012-11-30 Impact factor: 4.733
Authors: Carrie L Freeman; Tellen D Bennett; T Charles Casper; Gitte Y Larsen; Ania Hubbard; Jacob Wilkes; Susan L Bratton Journal: Crit Care Med Date: 2014-03 Impact factor: 7.598