Use of venovenous extracorporeal life support in pediatric patients for cardiac indications: a review of the Extracorporeal Life Support Organization registry.

Abstract

OBJECTIVE:

To describe survival outcomes for pediatric patients supported on venovenous extracorporeal life support with cardiac indications and identify predictors of successful application of venovenous extracorporeal life support.

DESIGN:

Retrospective review of Extracorporeal Life Support Organization registry database.

SETTING:

Data reported from extracorporeal membrane oxygenation centers to the Extracorporeal Life Support Organization.

PATIENTS:

Patients ≤18 yrs of age with cardiac diagnoses initiated on venovenous extracorporeal life support during 1985 to 2007.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 8,551 reported pediatric extracorporeal life support cases for cardiac indications during 1985 to 2007, 133 patients received venovenous extracorporeal life support (1.6%); 56 (42%) survived to hospital discharge, comprising the venovenous success group. Of 77 (58%) in the venovenous failure group, 45 (34%) died on venovenous extracorporeal life support and 32 (24%) were converted to venoarterial extracorporeal life support. Median duration of extracorporeal life support course was shorter in the venovenous success group (76 vs. 133 hrs, odds ratio 1.01, 95% confidence interval 1.00-1.01). In the univariate analysis, patients in the venovenous failure group had lower median arterial pH (odds ratio 0.06, 95% confidence intervals 0.01-0.61) and higher PaO(2) (odds ratio 1.02, 95% confidence interval 1.00-1.04). Complications from extracorporeal life support, including receipt of renal replacement therapy (odds ratio 4.35, 95% confidence interval 1.87-10.11), surgical hemorrhage (odds ratio 2.56, 95% confidence interval 1.05-6.25), use of inotropic infusions (odds ratio 2.53, 95% confidence interval 1.24-5.15), and infections (odds ratio 4.99, 95% confidence interval 1.07-23.25), were associated with increased odds for venovenous failure. In a multivariable model, the highest PaO(2) (PaO(2) ≥52 torr) compared to the lowest (PaO(2) ≤ 22 torr) (odds ratio 3.75, 95% confidence interval 1.11-12.57), and use of renal replacement therapy (odds ratio 4.35, 95% confidence interval 1.8710.11) were associated with increased odds of venovenous failure.

CONCLUSION:

Venovenous extracorporeal life support appears to be an appropriate choice in some children with cardiac failure but better definition of this population is needed.

• Authors: Kihan Kim, Robert L Mazor, Peter T Rycus, Thomas V Brogan
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 13 Issue 3 Pg. 285-9 (May 2012) ISSN: 1529-7535 [Print] United States
• PMID: 21926665 (Publication Type: Evaluation Study, Journal Article)

Topics

• Adolescent
• Child
• Child, Preschool
• Extracorporeal Circulation (methods)
• Female
• Heart Failure (mortality, therapy)
• Humans
• Infant
• Infant, Newborn
• Logistic Models
• Male
• Multivariate Analysis
• Registries
• Retrospective Studies
• Survival Rate
• Treatment Outcome