Predictors and outcomes of early post-operative veno-arterial extracorporeal membrane oxygenation following infant cardiac surgery

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dc.contributor.authorKuraim, Gabriela A
dc.contributor.authorGarros, Daniel
dc.contributor.authorRyerson, Lindsay
dc.contributor.authorMoradi, Fahimeh
dc.contributor.authorDinu, Irina A
dc.contributor.authorGarcia Guerra, Gonzalo
dc.contributor.authorModdemann, Diane
dc.contributor.authorBond, Gwen Y
dc.contributor.authorRobertson, Charlene M T
dc.contributor.authorJoffe, Ari R
dc.date.accessioned2018-11-07T17:09:28Z
dc.date.available2018-11-07T17:09:28Z
dc.date.issued2018-09-03
dc.date.updated2018-11-07T17:09:28Z
dc.description.abstractAbstract Background We aimed to determine predictors of, and outcomes after, veno-arterial extracorporeal membrane oxygenation instituted within 48 h after cardiac surgery (early ECMO) in young infants. Methods Patients ≤ 6 weeks old having cardiac surgery from 2003 to 2012 were enrolled prospectively. Patients cannulated pre-operatively, intra-operatively, or ≥ 48 h post-operatively were excluded. Variables at p ≤ 0.1 on univariate regression were entered into multiple logistic regression to predict early ECMO. Early-ECMO cases were matched 1:2 for six demographic variables, and death by age 2 years old (determined using conditional logistic regression; presented as odds ratio (OR), 95% confidence interval (CI)) and General Adaptive Composite scores at age 2 years (determined using Wilcoxon rank sum) were compared; p ≤ 0.05 was considered statistically significant. Results Of 565 eligible patients over the 10-year period, 20 had early ECMO instituted at a mean (standard deviation) of 12.4 (11.4) h post-operatively, 10 of whom had extracorporeal cardiopulmonary resuscitation. Of early-ECMO patients, 8 (40%) were found to have residual anatomic defects requiring intervention with catheterization (n = 1) and/or surgery (n = 7). On multiple regression, the post-operative day 1 highest vasoactive-inotrope score (OR 1.02; 95%CI 1.06,1.08; p < 0.001), highest lactate (OR 1.2; 95%CI 1.06,1.35; p = 0.003), and lowest base deficit (OR 0.82; 95%CI 0.71,0.94; p = 0.004), CPB time (OR 1.01; 95%CI 1.00,1.02; p = 0.002), and single-ventricle anatomy (OR 5.35; 95%CI 1.66,17.31; p = 0.005) were associated with early ECMO. Outcomes at 2 years old compared between early-ECMO and matched patients were mortality 11/20 (55%) vs 11/40 (28%) (OR 3.22, 95%CI 0.98,10.63; p = 0.054) and General Adaptive Composite median 65 [interquartile range (IQR) 58, 81.5] in 9 survivors vs 93 [IQR 86.5, 102.5] in 29 survivors (p = 0.02). Conclusions The identified risk factors for, and outcomes after, having early ECMO may aid decision making in the acute period and confirm that neurodevelopmental follow-up for these children is necessary. The hypothesis that earlier institution of ECMO may improve long-term outcomes requires further study.
dc.identifier.citationJournal of Intensive Care. 2018 Sep 03;6(1):56
dc.identifier.doihttps://doi.org/10.1186/s40560-018-0326-4
dc.identifier.urihttp://hdl.handle.net/1880/109100
dc.identifier.urihttps://doi.org/10.11575/PRISM/45954
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.titlePredictors and outcomes of early post-operative veno-arterial extracorporeal membrane oxygenation following infant cardiac surgery
dc.typeJournal Article
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