Use of Extracorporeal Membrane Oxygenation and Mortality in Pediatric Cardiac Surgery Patients With Genetic Conditions: A Multicenter Analysis*

Abstract

Objective Congenital heart disease is commonly a manifestation of Genetic Conditions (GC). Surgery and/or ECMO were withheld in the past from some patients with GC. We hypothesized that surgical care of children with GC has increased over the last decade but their cardiac ECMO use remains lower and mortality greater. Design Retrospective Cohort Study Setting Patients admitted to the Pediatric Health Information System database ≤18 years old with cardiac surgery during 2003–14. GC identified by ICD9 codes were grouped as: Trisomy 21 (T21), Trisomy 13 or 18 (T13/18), 22q11 deletion, and all “other” GC and compared to patients without GC Patients A total of 95,253 patients met study criteria, no GC (85%), T21 (10%), T13/18 (0.2%), 22q11 deletion (1%), and “others” (5%). Interventions None Measurements and Main Results Annual surgical cases did not vary over time. Compared to patients without GC, T21 patient ECMO use was just over half (OR 0.54), but mortality with and without ECMO were similar. In T13/18 patients, ECMO use was similar to those without GC, but all 5 treated with ECMO died. 22q11 patients compared to those without GC had similar ECMO use, but greater odds of ECMO mortality (OR 3.44). “Other” GC had significantly greater ECMO use (OR 1.22), mortality with ECMO (OR 1.42) and even greater mortality odds without (OR 2.62). Conclusions The proportion of children undergoing cardiac surgery who have GC did not increase during the study. Excluding T13/18, all groups of GCs received and benefited from ECMO, although ECMO mortality was greater for those with 22q11 deletion and “other” GC.

Predictors of extracorporeal membrane oxygenation support after surgery for adult congenital heart disease in children's hospitals

“…Previous studies of adult patients after cardiac surgery have not specifically examined DWE, although this was recently examined after pediatric cardiac surgery . We found that DWE occurred in 1.4% of adults undergoing ACHD surgery, similar to the rate of 1.6% in pediatric patients with no known genetic condition after cardiac surgery . As stated previously, a proportion of patients that die without ECMO could possibly have survived if they had been supported with ECMO.…”

“…Pediatric cardiac surgical programs routinely use extracorporeal membrane oxygenation (ECMO) to rescue surgical patients with cardiopulmonary failure, and predictors of ECMO support in these patients have been well documented . However, predictors of ECMO support in adults after CHD surgery have not been previously reported.…”

“…Currently, only a few reports have described factors associated with DWE in specific groups of children . Thus, understanding risk factors for ECMO support and DWE in ACHD surgical patients will improve presurgical discussion and planning in this population.…”

“…3,6 Pediatric cardiac surgical programs routinely use extracorporeal membrane oxygenation (ECMO) to rescue surgical patients with cardiopulmonary failure, and predictors of ECMO support in these patients have been well documented. [7][8][9][10][11] However, predictors of ECMO support in adults after CHD surgery have not been previously reported. Because adult patients are likely to be active participants in their medical decision making, identifying patients who are at increased risk of requiring ECMO support is important for presurgical discussion and planning.…”

“…Currently, only a few reports have described factors associated with DWE in specific groups of children. 8,14 Thus, understanding risk factors for ECMO support and DWE in ACHD surgical patients will improve presurgical discussion and planning in this population. For these reasons, we utilized a large administrative dataset to identify risk factors for ECMO and DWE in adults undergoing ACHD surgery in children's hospitals.…”