Explores the ESLO database for patients with Hypoplastic Left Heart Syndrome (HLHS) and ECMO requirement prior any surgical palliation in regards to outcome

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• 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).