Arrhythmias Requiring ECMO in Infants Without Structural Congenital Heart Disease

Well, Andrew; Fenrich, Arnold L.; Shmorhun, Daniel; Stromberg, Daniel; Lavinghousez, Preston; Beckerman, Ziv; Fraser, Charles D.; Mery, Carlos M.

doi:10.1007/s00246-021-02803-x

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…Explanations by study authors were grouped into individual-level, hospital-level, and systemic/structural factors (21). Individual-level primary themes were: 1) differential access to care (28, 30, 33, 106, 114, 122, 168, 170), 2) varying clinical presentations (26, 27, 30, 31, 80, 92, 128, 161, 168), 3) different religious/cultural preferences (26, 27, 80, 89, 93, 168), or other unmeasured individual SDoH as confounders (30, 84, 96). Hospital-level mechanisms included: 1) provider-level treatment variation (26, 31, 80, 93, 167, 169) and 2) between-hospital variability in offering ECMO, timing of initiation, organizational structure, experience, and standardized care practices/processes (27, 30, 31, 80, 90, 106, 122, 123, 129–131, 154, 157, 161, 168–173).…”

Section: Resultsmentioning

confidence: 99%

“…Of citations identifying adverse outcomes, 8 (22%) used univariate (77–84) and 28 (78%) used multivariate analyses. Of multivariate analyses, diverse populations, compared with nondiverse/White patients, were independently associated with mortality (26, 27, 29, 30, 32, 35, 85–100), adverse neurologic outcomes (101), or prolonged ECMO duration (34). One study showed higher adjusted mortality in patients with Hispanic ethnicity compared with Asian (102).…”

Section: Resultsmentioning

confidence: 99%

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Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

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Objectives: To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes. Data Sources: PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population). Study Selection: Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support. Data Extraction: Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool. Data Synthesis: Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors. Conclusions: Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

View full text Add to dashboard Cite

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“…Arrhythmias requiring ECMO support are rare in infants without structural congenital heart disease. Given the favorable survival rate, earlier and more aggressive ECMO use may lead to improved outcomes ( 24 ). Patients with postoperative severe arrhythmias might benefit from short-term treatment with ECMO in an emergency.…”

Section: Discussionmentioning

confidence: 99%

Successful extracorporeal membrane oxygenation for postoperative cardiopulmonary failure in newborns with congenital diaphragmatic hernia: case reports and literature reviews

et al. 2023

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IntroductionCongenital diaphragmatic hernia (CDH) is a structural defect caused by inadequate fusion of the pleuroperitoneal membrane that forms the diaphragm, allowing peritoneal viscera to protrude into the pleural cavity. Up to 30% of newborns with CDH require extracorporeal membrane oxygenation (ECMO) support. As with all interventions, the risks and benefits of ECMO must be carefully considered in these patients. Cardiopulmonary function has been shown to worsen rather than improve after surgical CDH repair. Even after a detailed perioperative assessment, sudden cardiopulmonary failure after surgery is dangerous and requires timely and effective treatments.MethodThree cases of cardiopulmonary failure after surgical CDH treatment in newborns have been reported. ECMO support was needed for these three patients and was successfully discontinued. We report our treatment experience.ConclusionECMO is feasible for the treatment of postoperative cardiopulmonary failure in newborns with CDH.

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“…In a pediatric extracorporeal membrane oxygenation registry, non‐White infants aged <1 year with arrhythmias (without CHD) had lower survival rates. 63 …”

Section: Electrophysiologymentioning

confidence: 99%

Addressing Disparities in Pediatric Congenital Heart Disease: A Call for Equitable Health Care

Chowdhury,

Elliott,

Asaki

et al. 2024

JAHA

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While significant progress has been made in reducing disparities within the US health care system, notable gaps remain. This article explores existing disparities within pediatric congenital heart disease care. Congenital heart disease, the most common birth defect and a leading cause of infant death, has garnered substantial attention, revealing certain disparities within the US health care system. Factors such as race, ethnicity, insurance coverage, socioeconomic status, and geographic location are all commonalities that significantly affect health disparities in pediatric congenital heart disease. This comprehensive review sheds light on disparities from diverse perspectives in pediatric care, demonstrates the inequities and inequalities leading to these disparities, presents effective solutions, and issues a call to action for providers, institutions, and the health care system. Recognizing and addressing these disparities is imperative for ensuring equitable care and enhancing the long‐term well‐being of children affected by congenital heart disease. Implementing robust, evidence‐based frameworks that promote responsible and safe interventions is fundamental to enduring change.

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Arrhythmias Requiring ECMO in Infants Without Structural Congenital Heart Disease

Cited by 5 publications

References 11 publications

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Successful extracorporeal membrane oxygenation for postoperative cardiopulmonary failure in newborns with congenital diaphragmatic hernia: case reports and literature reviews

Addressing Disparities in Pediatric Congenital Heart Disease: A Call for Equitable Health Care

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