Extracorporeal membrane oxygenation after stage 1 palliation for hypoplastic left heart syndrome

Sherwin, Elizabeth D.; Gauvreau, Kimberlee; Scheurer, Mark A.; Rycus, Peter; Salvin, Joshua W.; Almodovar, Melvin C.; Fynn‐Thompson, Francis; Thiagarajan, Ravi R.

doi:10.1016/j.jtcvs.2012.03.035

Cited by 89 publications

(108 citation statements)

References 8 publications

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“…In our series, 13.2% of children required ECMO after the Norwood operation, comparable with the results of the SVR trial (15.5%) [9]. Survival in our patients who required ECMO was 41.4%, which is favorable compared with hospital survival of 31% in a recent Extracorporeal Life Support Organization report that examined the outcomes in 738 neonates who required ECMO after the Norwood operation [24]. Furthermore, several reports showed that the long-term outcomes in hospital survivors who required ECMO support after the Norwood operation is poor [9,[25][26][27].…”

Section: Commentsupporting

confidence: 85%

Impact of Patient Characteristics and Anatomy on Results of Norwood Operation for Hypoplastic Left Heart Syndrome

Alsoufi

Mori

Gillespie

et al. 2015

The Annals of Thoracic Surgery

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This current single-institution experience demonstrates that patients' factors (ie, prematurity, low weight, genetic/extracardiac anomalies) continue to adversely affect survival. Conversely, surgical and perioperative management advances, along with the use of the right ventricle to pulmonary artery shunt, might have neutralized the effects of anatomic factors on survival. Technical imperfections requiring reoperations are associated with failure to progress through palliation stages and diminished survival.

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Section: Commentsupporting

confidence: 85%

Impact of Patient Characteristics and Anatomy on Results of Norwood Operation for Hypoplastic Left Heart Syndrome

Alsoufi

Mori

Gillespie

et al. 2015

The Annals of Thoracic Surgery

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“…Overall Patterns of ECMO Care: 1989 Overall, 290 ELSO centers provided ECMO support to 56,222 individuals (30,909 neonates, 14,725 children, and 10,588 adults). ECMO mortality rates for neonatal respiratory, cardiac, and ECPR were 26%, 59%, and 59%, respectively, compared with 43%, 49%, and 59% among pediatric patients and 43%, 60%, and 71% among adults.…”

Section: Resultsmentioning

confidence: 99%

“…The following variables were chosen: calendar year in which ECMO was delivered (15,23); patient age (23)(24)(25); primary diagnosis (23)(24)(25)(26)(27); ECMO support type (16,27); presence of pre-ECMO acute renal failure (23,26,27); presence of comorbid conditions (23,28); pre-ECMO cardiac arrest (25,29); and pre-ECMO measures including duration of mechanical ventilation (23,25,30), arterial blood pH (23,27,31), Pa CO 2 (25), and the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PF ratio) (1,23). In neonatal patients, case-mix was also adjusted for gestational age (24) and birth weight (24).…”

Section: Selection Of Variables and Risk Adjustmentmentioning

confidence: 99%

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Barbaro¹,

Odetola²,

Kidwell³

et al. 2015

Am J Respir Crit Care Med

575

400

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Rationale: Recent pediatric studies suggest a survival benefit exists for higher-volume extracorporeal membrane oxygenation (ECMO) centers.Objectives: To determine if higher annual ECMO patient volume is associated with lower case-mix-adjusted hospital mortality rate. Methods:We retrospectively analyzed an international registry of ECMO support from 1989 to 2013. Patients were separated into three age groups: neonatal (0-28 d), pediatric (29 d to ,18 yr), and adult (>18 yr). The measure of hospital ECMO volume was age group-specific and adjusted for patient-level case-mix and hospitallevel variance using multivariable hierarchical logistic regression modeling. The primary outcome was death before hospital discharge. A subgroup analysis was conducted for 2008-2013.Measurements and Main Results: From 1989 to 2013, a total of 290 centers provided ECMO support to 56,222 patients (30,909 neonates, 14,725 children, and 10,588 adults). Annual ECMO mortality rates varied widely across ECMO centers: the interquartile range was 18-50% for neonates, 25-66% for pediatrics, and 33-92% for adults. For 1989-2013, higher age group-specific ECMO volume was associated with lower odds of ECMO mortality for neonates and adults but not for pediatric cases. In 2008-2013, the volume-outcome association remained statistically significant only among adults. Patients receiving ECMO at hospitals with more than 30 adult annual ECMO cases had significantly lower odds of mortality (adjusted odds ratio, 0.61; 95% confidence interval, 0.46-0.80) compared with adults receiving ECMO at hospitals with less than six annual cases.Conclusions: In this international, case-mix-adjusted analysis, higher annual hospital ECMO volume was associated with lower mortality in 1989-2013 for neonates and adults; the association among adults persisted in 2008-2013.

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“…After stage I palliation, the rate of poor clinical outcomes is high, with survival estimates ranging from 31% to 38% in patients requiring ECMO and 37% in patients who had cardiac arrest requiring CPR. [22][23][24] The impact of adverse events on ventricular function is less defined. Our data revealed that there was an association between adverse events and ventricular dysfunction, with higher rates of transient and persistent dysfunction present in patients with adverse events after both stage I and stage II palliation.…”

Section: Impact Of Adverse Events On Ventricular Dysfunction and Survmentioning

confidence: 99%

Surgical Palliation Strategy Does Not Affect Interstage Ventricular Dysfunction or Atrioventricular Valve Regurgitation in Children With Hypoplastic Left Heart Syndrome and Variants

et al. 2013

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Background-All 3 palliation strategies, Norwood, Sano, and Hybrid, currently used for hypoplastic left heart syndrome pose a risk of myocardial injury at different times and through different mechanisms. We sought to compare these strategies to understand longitudinal differences in interstage ventricular dysfunction and their subsequent impact on transplant-free survival and atrioventricular valve regurgitation (AVVR) as well as the relationship between adverse events and ventricular function.

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Extracorporeal membrane oxygenation after stage 1 palliation for hypoplastic left heart syndrome

Abstract: Mortality for neonates with hypoplastic left heart syndrome supported with ECMO after stage 1 palliation is high. Longer ventilation before cannulation, longer support duration, and ECMO complications increased mortality.

Cited by 89 publications

References 8 publications

Impact of Patient Characteristics and Anatomy on Results of Norwood Operation for Hypoplastic Left Heart Syndrome

Impact of Patient Characteristics and Anatomy on Results of Norwood Operation for Hypoplastic Left Heart Syndrome

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Surgical Palliation Strategy Does Not Affect Interstage Ventricular Dysfunction or Atrioventricular Valve Regurgitation in Children With Hypoplastic Left Heart Syndrome and Variants

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