Risk factors and outcomes of pediatric extracorporeal membrane oxygenation
Background Congenital heart disease (CHD) is the most common neonatal and pediatric cardiac indication for extracorporeal membrane oxygenation (ECMO). Risk factors of survival and neurologic complication were different in many centers. We sought to evaluate survival and neurological outcome after EC...
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| Veröffentlicht in: | Asian cardiovascular & thoracic annals 2021-11, Vol.29 (9), p.916-921 |
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| container_title | Asian cardiovascular & thoracic annals |
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| creator | Taka, Hiroshi Kotani, Yasuhiro Kuroko, Yosuke Iwadou, Susumu Iwasaki, Tatsuo Kasahara, Shingo |
| description | Background
Congenital heart disease (CHD) is the most common neonatal and pediatric cardiac indication for extracorporeal membrane oxygenation (ECMO). Risk factors of survival and neurologic complication were different in many centers. We sought to evaluate survival and neurological outcome after ECMO in patients with CHD.
Methods
We retrospectively reviewed the medical records of 37 patients (1 week and urine output |
| doi_str_mv | 10.1177/0218492321997379 |
| format | Article |
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Congenital heart disease (CHD) is the most common neonatal and pediatric cardiac indication for extracorporeal membrane oxygenation (ECMO). Risk factors of survival and neurologic complication were different in many centers. We sought to evaluate survival and neurological outcome after ECMO in patients with CHD.
Methods
We retrospectively reviewed the medical records of 37 patients (<16 years old) who received ECMO. Indications for ECMO were failure to wean from cardiopulmonary bypass in 18 patients, extracorporeal cardiopulmonary resuscitation (ECPR) in 13 patients, and others in 6 patients. The median cardiopulmonary resuscitation (CPR) duration in ECPR patients was 48 min (interquartile range: 38–53 min). Neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) scale one year after hospital discharge.
Results
The median ECMO duration was 160 (91–286) h. Twenty-nine patients (78%) were successfully weaned off ECMO. Overall survival to hospital discharge was 59%. Risk factors of mortality were as follows: ECMO duration >1 week and urine output <1 mL/kg/h in the first 24 h after ECMO induction by multivariable analysis. Of the 22 survivors, 15 (68%) patients had a favorable outcome (PCPC ≤2). Risk factors for unfavorable outcomes (PCPC ≥3) included ECPR as indication and CPR of longer than 40 min.
Conclusions
Longer ECMO duration and lower urine output were associated with increased mortality. Neurologic outcomes were not satisfactory when CPR was required for a longer period before ECMO establishment.</description><identifier>ISSN: 0218-4923</identifier><identifier>EISSN: 1816-5370</identifier><identifier>DOI: 10.1177/0218492321997379</identifier><identifier>PMID: 33611945</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adolescent ; Cardiopulmonary Resuscitation ; Child ; Extracorporeal Membrane Oxygenation - adverse effects ; Heart Defects, Congenital - diagnosis ; Heart Defects, Congenital - therapy ; Humans ; Infant, Newborn ; Retrospective Studies ; Risk Factors ; Treatment Outcome</subject><ispartof>Asian cardiovascular & thoracic annals, 2021-11, Vol.29 (9), p.916-921</ispartof><rights>The Author(s) 2021</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-e959fa70a49c7a17b19a72c203eeb0b773a64f56fad60d99bc81a28d7a0bb3bd3</citedby><cites>FETCH-LOGICAL-c337t-e959fa70a49c7a17b19a72c203eeb0b773a64f56fad60d99bc81a28d7a0bb3bd3</cites><orcidid>0000-0003-2693-2108</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0218492321997379$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0218492321997379$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33611945$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Taka, Hiroshi</creatorcontrib><creatorcontrib>Kotani, Yasuhiro</creatorcontrib><creatorcontrib>Kuroko, Yosuke</creatorcontrib><creatorcontrib>Iwadou, Susumu</creatorcontrib><creatorcontrib>Iwasaki, Tatsuo</creatorcontrib><creatorcontrib>Kasahara, Shingo</creatorcontrib><title>Risk factors and outcomes of pediatric extracorporeal membrane oxygenation</title><title>Asian cardiovascular & thoracic annals</title><addtitle>Asian Cardiovasc Thorac Ann</addtitle><description>Background
Congenital heart disease (CHD) is the most common neonatal and pediatric cardiac indication for extracorporeal membrane oxygenation (ECMO). Risk factors of survival and neurologic complication were different in many centers. We sought to evaluate survival and neurological outcome after ECMO in patients with CHD.
Methods
We retrospectively reviewed the medical records of 37 patients (<16 years old) who received ECMO. Indications for ECMO were failure to wean from cardiopulmonary bypass in 18 patients, extracorporeal cardiopulmonary resuscitation (ECPR) in 13 patients, and others in 6 patients. The median cardiopulmonary resuscitation (CPR) duration in ECPR patients was 48 min (interquartile range: 38–53 min). Neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) scale one year after hospital discharge.
Results
The median ECMO duration was 160 (91–286) h. Twenty-nine patients (78%) were successfully weaned off ECMO. Overall survival to hospital discharge was 59%. Risk factors of mortality were as follows: ECMO duration >1 week and urine output <1 mL/kg/h in the first 24 h after ECMO induction by multivariable analysis. Of the 22 survivors, 15 (68%) patients had a favorable outcome (PCPC ≤2). Risk factors for unfavorable outcomes (PCPC ≥3) included ECPR as indication and CPR of longer than 40 min.
Conclusions
Longer ECMO duration and lower urine output were associated with increased mortality. Neurologic outcomes were not satisfactory when CPR was required for a longer period before ECMO establishment.</description><subject>Adolescent</subject><subject>Cardiopulmonary Resuscitation</subject><subject>Child</subject><subject>Extracorporeal Membrane Oxygenation - adverse effects</subject><subject>Heart Defects, Congenital - diagnosis</subject><subject>Heart Defects, Congenital - therapy</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><issn>0218-4923</issn><issn>1816-5370</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM1Lw0AUxBdRbK3ePckevUT3I8lmj1L8pCCInsPbzUtJTbJxN4H2vzeh1YPg6R3mN8ObIeSSsxvOlbplgmexFlJwrZVU-ojMecbTKJGKHZP5JEeTPiNnIWwYY5LL7JTMpEw513EyJy9vVfikJdje-UChLagbeusaDNSVtMOigt5XluK292Cd75xHqGmDjfHQInXb3Rpb6CvXnpOTEuqAF4e7IB8P9-_Lp2j1-vi8vFtFVkrVR6gTXYJiEGurgCvDNShhBZOIhhmlJKRxmaQlFCkrtDY24yCyQgEzRppCLsj1Prfz7mvA0OdNFSzW9fiPG0IuxsYiS8eKI8r2qPUuBI9l3vmqAb_LOcunBfO_C46Wq0P6YBosfg0_k41AtAcCrDHfuMG3Y9v_A78BFp95bA</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Taka, Hiroshi</creator><creator>Kotani, Yasuhiro</creator><creator>Kuroko, Yosuke</creator><creator>Iwadou, Susumu</creator><creator>Iwasaki, Tatsuo</creator><creator>Kasahara, Shingo</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2693-2108</orcidid></search><sort><creationdate>202111</creationdate><title>Risk factors and outcomes of pediatric extracorporeal membrane oxygenation</title><author>Taka, Hiroshi ; Kotani, Yasuhiro ; Kuroko, Yosuke ; Iwadou, Susumu ; Iwasaki, Tatsuo ; Kasahara, Shingo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-e959fa70a49c7a17b19a72c203eeb0b773a64f56fad60d99bc81a28d7a0bb3bd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Cardiopulmonary Resuscitation</topic><topic>Child</topic><topic>Extracorporeal Membrane Oxygenation - adverse effects</topic><topic>Heart Defects, Congenital - diagnosis</topic><topic>Heart Defects, Congenital - therapy</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><toplevel>online_resources</toplevel><creatorcontrib>Taka, Hiroshi</creatorcontrib><creatorcontrib>Kotani, Yasuhiro</creatorcontrib><creatorcontrib>Kuroko, Yosuke</creatorcontrib><creatorcontrib>Iwadou, Susumu</creatorcontrib><creatorcontrib>Iwasaki, Tatsuo</creatorcontrib><creatorcontrib>Kasahara, Shingo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Asian cardiovascular & thoracic annals</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Taka, Hiroshi</au><au>Kotani, Yasuhiro</au><au>Kuroko, Yosuke</au><au>Iwadou, Susumu</au><au>Iwasaki, Tatsuo</au><au>Kasahara, Shingo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors and outcomes of pediatric extracorporeal membrane oxygenation</atitle><jtitle>Asian cardiovascular & thoracic annals</jtitle><addtitle>Asian Cardiovasc Thorac Ann</addtitle><date>2021-11</date><risdate>2021</risdate><volume>29</volume><issue>9</issue><spage>916</spage><epage>921</epage><pages>916-921</pages><issn>0218-4923</issn><eissn>1816-5370</eissn><abstract>Background
Congenital heart disease (CHD) is the most common neonatal and pediatric cardiac indication for extracorporeal membrane oxygenation (ECMO). Risk factors of survival and neurologic complication were different in many centers. We sought to evaluate survival and neurological outcome after ECMO in patients with CHD.
Methods
We retrospectively reviewed the medical records of 37 patients (<16 years old) who received ECMO. Indications for ECMO were failure to wean from cardiopulmonary bypass in 18 patients, extracorporeal cardiopulmonary resuscitation (ECPR) in 13 patients, and others in 6 patients. The median cardiopulmonary resuscitation (CPR) duration in ECPR patients was 48 min (interquartile range: 38–53 min). Neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) scale one year after hospital discharge.
Results
The median ECMO duration was 160 (91–286) h. Twenty-nine patients (78%) were successfully weaned off ECMO. Overall survival to hospital discharge was 59%. Risk factors of mortality were as follows: ECMO duration >1 week and urine output <1 mL/kg/h in the first 24 h after ECMO induction by multivariable analysis. Of the 22 survivors, 15 (68%) patients had a favorable outcome (PCPC ≤2). Risk factors for unfavorable outcomes (PCPC ≥3) included ECPR as indication and CPR of longer than 40 min.
Conclusions
Longer ECMO duration and lower urine output were associated with increased mortality. Neurologic outcomes were not satisfactory when CPR was required for a longer period before ECMO establishment.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>33611945</pmid><doi>10.1177/0218492321997379</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-2693-2108</orcidid></addata></record> |
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| ispartof | Asian cardiovascular & thoracic annals, 2021-11, Vol.29 (9), p.916-921 |
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| language | eng |
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| source | MEDLINE; SAGE Complete |
| subjects | Adolescent Cardiopulmonary Resuscitation Child Extracorporeal Membrane Oxygenation - adverse effects Heart Defects, Congenital - diagnosis Heart Defects, Congenital - therapy Humans Infant, Newborn Retrospective Studies Risk Factors Treatment Outcome |
| title | Risk factors and outcomes of pediatric extracorporeal membrane oxygenation |
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