Factors Associated with the Need for, and the Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital Heart Disease during Admissions for Cardiac Surgery

Abstract

Introduction: This study aimed to determine factors associated with the need for extracorporeal membrane oxygenation (ECMO) in children with congenital heart disease (CHD) during admission for cardiac surgery (CS). A secondary aim was to determine how ECMO impacted length, cost, and mortality of the admission. Methods: Data from the Kids’ Inpatient Database (KIDS) were utilized. Admissions with CHD under 18 years of age with cardiac surgery were included. Need for ECMO in these admissions was then identified. Univariate analysis was conducted to compare characteristics between admissions with and without ECMO. Regression analyses were conducted to determine what factors were independently associated with ECMO and whether ECMO independently impacted admission characteristics. Results: A total of 46,176 admissions with CHD and CS were included in the final analysis. Of these, 798 (1.7%) required ECMO. Median age of ECMO admissions was 0.5 years. The following were associated with ECMO: decreased age, heart failure, acute kidney injury, arrhythmia, double outlet right ventricle, atrioventricular septal defect, transposition, Ebstein anomaly, hypoplastic left heart syndrome, common arterial trunk, tetralogy of Fallot, coronary anomaly, valvuloplasty, repair of total anomalous pulmonary venous connection, arterial switch, RV to PA conduit placement, and heart transplant (p < 0.01). ECMO independently increased length of stay by 17.8 days, cost of stay by approximately $415,917, and inpatient mortality 22-fold. Conclusion: Only a small proportion of CHD patients undergoing CS require ECMO, although these patients require increased resource utilization and have high mortality. Specific cardiac lesions, cardiac surgeries, and comorbidities are associated with increased need for ECMO.

Outcomes and factors associated with early mortality in pediatric and neonatal patients requiring extracorporeal membrane oxygenation for heart and lung failure

“…The use of ECMO for cardiac disease has grown over time with an ever-shrinking numbers of contraindications involving the sickest and complicated babies and children. Today approximately 2-5% of neonatal and pediatric patients after cardiac surgery may require ECMO for cardio-respiratory support (16)(17)(18)(19)(20)(21).…”

“…Despite their improving efficacy, ECMO and ECLS utilization varies between different institutions based on various factors, such as experience, logistics, and manpower availability. Skilled personnel and appropriate financial means remain the most important prerequisites for socioeconomic aspects of this expensive therapy (3,17,(23)(24)(25).…”

Antithrombin use during pediatric cardiac extracorporeal membrane oxygenation admission: insights from a national database

“…2,3 A particularly vulnerable and demanding subset of these patients are the patients with complex congenital heart disease, especially if they require ECMO. 4,5 Patients requiring ECMO are in compromised state initiating native coagulopathy and then as patient blood contacts the ECMO circuit, the tubing and oxygenator surface consume plasma proteins and activate the coagulation processes and increase the potential of clotting proteins forming a thrombus. 6,7 From the reported incidences in adults, the coagulopathies are more dynamic in pediatric patients and further intensify in neonates, with all groups reporting effects on the first day on ECMO.…”

Pediatric patients requiring extracorporeal membrane oxygenation in heart failure: 30‐day outcomes; mid‐ and long‐term survival. A single center experience

“…Despite their improving efficacy, ECMO utilization varies among different institutions based on diver's factors, such as experience, logistics, and manpower availability. Skilled personnel and appropriate financial founding remain the most important prerequisites for socioeconomic aspects of this expensive therapy . Limited data exist on 30‐day as well as mid‐ and long‐term survival for neonatal and pediatric patients requiring ECMO support.…”