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Extracorporeal Life Support (ECMO) prior Stage 1 surgical palliation in Hypoplastic Left Heart Syndrome - PICC 2016

Attending CVICU at Texas Children's Hospital à Texas Children's Hospital
3 Jun 2017
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Extracorporeal Life Support (ECMO) prior Stage 1 surgical palliation in Hypoplastic Left Heart Syndrome - PICC 2016

  1. Page 1 • Extracorporeal membrane oxygenation (ECMO) has been shown to provide effective cardiopulmonary support post congenital heart surgery. • Survival rates reported by the Extracorporeal Life Support Organisation (ELSO) international summary range from 35% to 47% for cardiac ECMO. • The goal of this review is to describe outcomes of patients with Hypoplastic Left Heart Syndrome (HLHS) supported with ECMO prior to any surgical palliation (either Norwood or Damus-Kaye-Stansel (DKS)) based on multicentre data reported to ELSO. • ELSO registry (Ann Arbor, MI) was queried for all neonates ((≤ 30 days) with HLHS requiring ECMO support prior to any definitive surgical palliation from January 2004 – 2015 • Descriptive data are presented as median with interquartile ranges (IQR 25th - IQR 75th percentile) or frequencies (n) with proportion (%) where appropriate. For patients with multiple ECMO runs (n = 2), only data from the first run were analyzed. • The overall survival (32%) to discharge in patients with HLHS bridged with ECMO to initial palliative surgery is poor. RESULTS References [1] GhanayemNS, Allen KR, Tabbutt S, et al: Interstage mortality after the Norwood procedure: Results of the multicenter Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg. 2012 Oct;144(4):896-906 [2] Hintz SR, Benitz WE, Colby CE, et al: Utilization and outcomesof neonatalcardiac extracorporeal life support:1996–2000. Pediatr Crit Care Med 2005; 6:33–38 BACKGROUND METHODS DISCUSSION CONCLUSION LIMITATIONS Extracorporeal Life support prior to surgical palliation for Hypoplastic Left Heart Syndrome M. Anders, H. Chandler, S. Tume, J. Thomas, P. Checcia Section of Pediatric Critical Care Medicine, Texas Children’s Hospital, Houston, TX • Infants with HLHS represent one of the most clinically challenging and highest mortality risk groups of patients with congenital heart disease. Inter-stage mortality has significantly improved over the last decade with an overall mortality of less than 12% [1]. • Bridging children with ECMO to definitive or palliative congenital cardiac surgical repair is challenging, with only a few institutional reports in the literature. Our data concurs with the results of Hintz et al [2] who showed in an ELSO database review from 1996 – 2000 for neonates supported with ECMO prior surgery for cardiac problems an overall survival rate of 34.2%. • The major limitation of this study is its retrospective nature, with data quality affected by the reliability and accuracy of individual centres who enter data into the ELSO database. • Furthermore 26 out of 76 patients were classified to require CPB prior ECMO and three patients had a pacemaker used prior ECMO leads to further confusion of the primary data. In some parameters source data is missing more than in 20%. • We did not include patients with HLHS who underwent ECMO, but didn’t have subsequent surgical correction. • 76 patients underwent 78 ECMO runs pre surgical palliation for HLHS. • The overall survival to discharge home or another facility was 32% (n=24). • There were no differences between survivors and non-survivors regarding weight, timing of employment of ECMO, gestational age, birth weight, APGAR at 1 minute or 5 minutes, sex or race. • The median mean arterial blood pressure was significantly higher in the survivor group (50 vs. 40 mmHg, p = 0.01). In a simple and multiple logistic regression model, this was the only significant predictor of pre ECMO variables on mortality (OR 0.89, p < 0.03). • Survivors had significantly shorter ECMO support duration than non-survivors (88.5 vs. 154 hours, p < 0.01). Compared to survivors, non-survivors required more inotropic support while on ECMO (71% vs 38%) and more frequent renal replacement therapy (60% vs 33%). In a multivariable regression model, the odds of mortality increase by 1.01 for an hour increase in time on ECMO (p < 0.02) and those on renal replacement therapy have increased odds of mortality (OR = 9.19; p < 0.03).
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