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

Shah, Shawn; Kays, David W.; Ghazarian, Sharon R.; Karl, Tom R.; Alexander, Plato; Sznycer-Taub, Nathaniel; Parker, Jason; Oldeen, Molly Elisabeth; Almodovar, Melvin C.; Stapleton, Gary; Quintessenza, James A.; Asante‐Korang, Alfred; Kartha, Vyas M.; Hanson, Jade; Amankwah, Ernest K.; Roth, Joeli; Jacobs, Jeffrey P.

doi:10.1017/s1047951118001282

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…Many ECMO-centres offer treatment to CDH-infants, when conventional treatments fail. However, despite improved technology, ECMO treatment is associated with severe complications [8] and evidence of causal effect on long term survival in CDH-populations is lacking [9,10].…”

Section: Introductionmentioning

confidence: 99%

Congenital diaphragmatic hernia presenting with symptoms within the first day of life; outcomes from a non-ECMO centre in Denmark

et al. 2020

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Background: Between 1998 and 2015, we report on the survival of congenital diaphragmatic hernia (CDH)-infants presenting with symptoms within the first 24 h of life, treated at Odense University Hospital (OUH), a tertiary referral non-extracorporeal membrane oxygenation (ECMO) hospital for paediatric surgery. Methods:We performed a retrospective cohort study of prospectively identified CDH-infants at our centre. Data from medical records and critical information systems were obtained. Baseline data included mode of delivery and infant condition. Outcome data included 24-h, 28-day, and 1 year mortality rates and management data included intensive care treatment, length of stay in the intensive care unit, time of discharge from hospital, and surgical intervention. Descriptive analyses were performed for all variables. Survivors and non-survivors were compared for baseline and treatment data.Results: Ninety-five infants were identified (44% female). Of these, 77% were left-sided hernias, 52% were diagnosed prenatally, and 6.4% had concurrent malformations. The 28-day mortality rate was 21.1%, and the 1 year mortality rate was 22.1%. Of the 21 non-survivors, nine died within the first 24 h, and 10 were sufficiently stabilised to undergo surgery. A statistically significant difference was observed between survivors and non-survivors regarding APGAR score at 1 and 5 min., prenatal diagnosis, body length at birth, and delivery at OUH. Conclusions:Our outcome results were comparable to published data from other centres, including centres using ECMO.

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Section: Introductionmentioning

confidence: 99%

Congenital diaphragmatic hernia presenting with symptoms within the first day of life; outcomes from a non-ECMO centre in Denmark

et al. 2020

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“…In a retrospective cohort study of 223 patients who underwent 241 extracorporeal membrane oxygenation runs (8 October, 1998 through 25 July, 2016), median support time was 4.0 days (range = 0.04-55.8 days, mean = 6.4 ± 7.0 days). 7 Our patient's duration on extracorporeal membrane oxygenation for 394 days as a bridge to cardiac transplantation is unprecedented.…”

Section: Discussionmentioning

confidence: 99%

Support with extracorporeal membrane oxygenation for over 1 year duration as a bridge to cardiac transplantation: a case report and review of the literature

et al. 2021

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We present the case of a 13-year-old male with a complex congenital cardiac history who was supported with extracorporeal membrane oxygenation for 394 days while awaiting cardiac transplantation. The patient underwent successful cardiac transplantation after 394 days of support with veno-arterial extracorporeal membrane oxygenation and is currently alive 2 years after cardiac transplantation. We believe that this case represents the longest period of time that a patient has been supported with extracorporeal membrane oxygenation as a bridge to cardiac transplantation. We also review the literature associated with prolonged support with extracorporeal membrane oxygenation. This case report documents many of the challenges associated with prolonged support with extracorporeal membrane oxygenation, including polymicrobial bacterial and fungal infections, as well as renal dysfunction. It is possible to successfully bridge a patient to cardiac transplantation with prolonged support with extracorporeal membrane oxygenation of over 1 year; however, multidisciplinary collaboration is critical.

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“…Our results can be compared to other studies of VAD in paediatric patients. Huang et al 10 reported a 61% survival to transplantation and 7% that were successfully weaned from the device following recovery, while Shah et al 2 reported a 54% survival to discharge. Although our results must be interpreted with caution due to the limited study population and potential confounding factors, along with the findings of Morales et al, 14 the present results indicate a trend of decreasing mortality during VAD treatment in children in more recent years, since the mortality rates reported about 15 years ago were above 20% 15,16 .…”

Section: Discussionmentioning

confidence: 99%

“…In paediatric patients, the three main reasons for using mechanical circulatory support (MCS) such as VAD treatment are cardiomyopathy, congenital heart defects and myocarditis. In these cases a VAD treatment could serve as a bridge to a heart transplant, or less commonly to recovery after surgery 2,3 . Temporary extracorporeal membrane oxygenation (ECMO) is a common therapy in children in the acute phase but is not a feasible solution for the mid to long term, since adverse events often multiply after 2‐3 weeks of treatment 2,4,5 .…”

Section: Introductionmentioning

confidence: 99%

“…In these cases a VAD treatment could serve as a bridge to a heart transplant, or less commonly to recovery after surgery 2,3 . Temporary extracorporeal membrane oxygenation (ECMO) is a common therapy in children in the acute phase but is not a feasible solution for the mid to long term, since adverse events often multiply after 2‐3 weeks of treatment 2,4,5 . VAD therapy thus has its place as a way of prolonging survival until recovery or until a transplant is possible.…”

Section: Introductionmentioning

confidence: 99%

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Clinical course and outcome after treatment with ventricular assist devices in paediatric patients: A single‐centre experience

Romlin

Dahlin

Hallhagen

et al. 2021

Acta Anaesthesiol Scand

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Background Heart failure is a rare condition in the paediatric population, associated with high morbidity and mortality. When medical therapy is no longer sufficient, mechanical circulatory support such as a ventricular assist device can be used to bridge these children to transplant or recovery. Coagulation‐related complications such as thrombi, embolism and bleeding events represent the greatest challenge in paediatric patients on mechanical support. We aimed to describe the outcomes and coagulation‐related complications in this patient population at our institution. Methods A total of 20 patients with either Berlin Heart EXCOR® or HeartWare® implantation were reviewed in this retrospective study. Study endpoints were survival to heart transplant, weaning due to recovery or death. Thrombotic events were defined as thrombus formation in the device or in the patient, or cardioembolic strokes. Bleeding events were defined as events requiring interventional surgery or transfusion of red blood cells. Results The aetiology of heart failure included cardiomyopathy (n = 12), end‐stage congenital heart disease (n = 6) and myocarditis (n = 2). Of the 20 patients, 12 were bridged to transplant, 7 recovered and could be weaned and 1 died. The median duration of mechanical support was 84 days (range: 20‐524 days). At least one major or minor bleeding event occurred in 45% of the patients. Thrombotic events occurred 21 times in 10 patients. Four of the patients (20%) had no bleeding or thromboembolic event. Conclusion In all, 95% of the patients were successfully bridged to transplant or recovery. Bleeding events and thrombotic events were common.

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

Cited by 4 publications

References 15 publications

Congenital diaphragmatic hernia presenting with symptoms within the first day of life; outcomes from a non-ECMO centre in Denmark

Congenital diaphragmatic hernia presenting with symptoms within the first day of life; outcomes from a non-ECMO centre in Denmark

Support with extracorporeal membrane oxygenation for over 1 year duration as a bridge to cardiac transplantation: a case report and review of the literature

Clinical course and outcome after treatment with ventricular assist devices in paediatric patients: A single‐centre experience

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