Eighteen years of paediatric extracorporeal membrane oxygenation and ventricular assist devices: insight regarding late outcomes

• Published in: Cardiology in the young 2018-11, Vol.28 (11), p.1316-1322
• Main Authors: Shah, Shawn M., Kays, David W., Ghazarian, Sharon R., Karl, Tom R., Alexander, Plato, Sznycer-Taub, Nathaniel, Parker, Jason, Oldeen, Molly, Almodovar, Melvin C., Stapleton, Gary, Quintessenza, James A., Asante-Korang, Alfred, Kartha, Vyas, Hanson, Jade, Amankwah, Ernest, Roth, Joeli, Jacobs, Jeffrey P.
• Format: Article
• Language: English
• Subjects: Age; Cannulation; Cardiomyopathy; Cardiovascular disease; Congenital diseases; Diagnosis; Diagnostic systems; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - methods; Female; Follow-Up Studies; Forecasting; Heart; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Heart diseases; Heart failure; Heart surgery; Heart-Assist Devices; Hernia; Hospitals; Humans; Indication; Infant; Infant, Newborn; Kaplan-Meier Estimate; Male; Mortality; Myocarditis; Original Article; Oxygenation; Patients; Pediatrics; Respiratory therapy; Retrospective Studies; Stem cells; Surgical apparatus & instruments; Survival; Survival Rate - trends; Transplants & implants; United Kingdom - epidemiology; Ventricle; Ventricular assist devices
• ISSN: 1047-9511; 1467-1107
• DOI: 10.1017/S1047951118001282

We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality. A retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan-Meier method. A total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan-Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan-Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%. This single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannu