scholarly journals 34: EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT: A BRIDGE TO PALLIATION IN SINGLE-VENTRICLE PHYSIOLOGY

2021 ◽  
Vol 50 (1) ◽  
pp. 17-17
Author(s):  
Ivana Capin ◽  
George Ofori-Amanfo ◽  
Maria Esperanza ◽  
Raghav Murthy ◽  
Gary Oldenburg ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Single Ventricle ◽  
Single Ventricle Physiology ◽  
Membrane Oxygenation

Risk factors for mortality in paediatric cardiac ICU patients managed with extracorporeal membrane oxygenation

2018 ◽  
Vol 29 (1) ◽  
pp. 40-47
Author(s):  
Barbara-Jo Achuff ◽  
Matthew D. Elias ◽  
Richard F. Ittenbach ◽  
Chitra Ravishankar ◽  
Susan C. Nicolson ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Cardiac Disease ◽  
Single Ventricle ◽  
Night Shift ◽  
Cardiac Patients ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Single Ventricle Physiology ◽  
Membrane Oxygenation ◽  
Surgical Group

AbstractBackgroundVeno-arterial extracorporeal membrane oxygenation is frequently used in patients with cardiac disease. We evaluated short-term outcomes and identified factors associated with hospital mortality in cardiac patients supported with veno-arterial extracorporeal membrane oxygenation.MethodsA retrospective review of patients supported with veno-arterial extracorporeal membrane oxygenation at a university-affiliated children’s hospital was performed.ResultsA total of 253 patients with cardiac disease managed with extracorporeal membrane oxygenation were identified; survival to discharge was 48%, which significantly improved from 39% in an earlier era (1995–2001) (p=0.01). Patients were categorised into surgical versus non-surgical groups on the basis of whether they had undergone cardiac surgery before or not, respectively. The most common indication for extracorporeal membrane oxygenation was extracorporeal cardiopulmonary resuscitation: 96 (51%) in the surgical group and 45 (68%) in the non-surgical group. In a multiple covariate analysis, single-ventricle physiology (p=0.01), duration of extracorporeal membrane oxygenation (p<0.01), and length of hospital stay (p=0.03) were associated with hospital mortality. Weekend or night shift cannulation was associated with mortality in non-surgical patients (p=0.05).ConclusionWe report improvement in survival compared with an earlier era in cardiac patients supported with extracorporeal membrane oxygenation. Single-ventricle physiology continues to negatively impact survival, along with evidence of organ dysfunction during extracorporeal membrane oxygenation, duration of extracorporeal membrane oxygenation, and length of stay.

Characterization of Extracorporeal Membrane Oxygenation Support for Single Ventricle Patients

2020 ◽  
Vol 11 (2) ◽  
pp. 183-191
Author(s):  
Elizabeth H. Stephens ◽  
Aqsa Shakoor ◽  
Shimon E. Jacobs ◽  
Shunpei Okochi ◽  
Ariela L. Zenilman ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Single Ventricle ◽  
Early Recognition ◽  
Orthotopic Heart Transplantation ◽  
Factors Associated ◽  
Membrane Oxygenation ◽  
End Point ◽  
Thrombotic Complications ◽  
Central Cannulation

Background: Extracorporeal membrane oxygenation (ECMO) can provide crucial support for single ventricle (SV) patients at various stages of palliation. However, characterization of the utilization and outcomes of ECMO in these unique patients remains incompletely studied. Methods: We performed a single-center retrospective review of SV patients between 2010 and 2017 who underwent ECMO cannulation with primary end point of survival to discharge and secondary end point of survival to decannulation or orthotopic heart transplantation (OHT). Multivariate analysis was performed for factors predictive of survival to discharge and survival to decannulation. Results: Forty SV patients with a median age of one month (range: 3 days to 15 years) received ECMO support. The incidence of ECMO was 14% for stage I, 3% for stage II, and 4% for stage III. Twenty-seven (68%) patients survived to decannulation, and 21 (53%) patients survived to discharge, with seven survivors to discharge undergoing OHT. Complications included infection (40%), bleeding (40%), thrombosis (33%), and radiographic stroke (45%). Factors associated with survival to decannulation included pre-ECMO lactate (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.41-0.90, P = .013) and post-ECMO bicarbonate (HR: 1.24, 95% CI: 1.0-1.5, P = .018). Factors associated with survival to discharge included central cannulation (HR: 40.0, 95% CI: 3.1-500.0, P = .005) and lack of thrombotic complications (HR: 28.7, 95% CI: 2.1-382.9, P = .011). Conclusions: Extracorporeal membrane oxygenation can be useful to rescue SV patients with approximately half surviving to discharge, although complications are frequent. Early recognition of the role of heart transplant is imperative. Further study is required to identify areas for improvement in this population.

Improved outcomes in neonates who require venoarterial extracorporeal membrane oxygenation after the Norwood procedure

2019 ◽  
Vol 43 (3) ◽  
pp. 180-188 ◽  
Author(s):  
Nicole De Jesus-Brugman ◽  
Michael Joe Hobson ◽  
Jeremy L Herrmann ◽  
Matthew L Friedman ◽  
Timothy Cordes ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Single Ventricle ◽  
Norwood Procedure ◽  
Proportional Hazard ◽  
Free Survival ◽  
Hospital Survival ◽  
Membrane Oxygenation ◽  
Cox Proportional Hazard ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Cox Proportional Hazard Regression

Background: Extracorporeal membrane oxygenation after the Norwood procedure has historically been associated with poor outcomes, with reported hospital survival rates of 13%–48%. We hypothesized that contemporary outcomes in this population have improved. We aimed to compare clinical outcomes of contemporary cohorts of patients with functional single ventricle physiology who did and did not receive extracorporeal membrane oxygenation after the Norwood procedure. Methods: Single-center retrospective cohort study of patients with single ventricle anatomy who underwent the Norwood procedure between 2009 and 2017 was performed. Kaplan–Meier survival curves were constructed, and Cox proportional hazard regression analyses were performed to compare transplant-free survival in patients who did and did not receive venoarterial extracorporeal membrane oxygenation. Results: In total, 85 patients met inclusion criteria. Venoarterial extracorporeal membrane oxygenation was utilized in 25 patients (29%). A total of 18 patients (72%) who received venoarterial extracorporeal membrane oxygenation survived to hospital discharge, compared to 54 patients (92%) who did not receive venoarterial extracorporeal membrane oxygenation (p = 0.013). Post-discharge transplant-free survival was not significantly different between patients who did and did not receive venoarterial extracorporeal membrane oxygenation (log-rank p value = 0.28). Cox proportional hazard regression analysis revealed that the occurrence of cardiac arrest requiring cardiopulmonary resuscitation (hazard ratio = 4.5; 95% confidence interval = 2.0–10.1) during the perioperative period was independently associated with death or transplantation, whereas venoarterial extracorporeal membrane oxygenation was not an independent risk factor for death or transplantation (hazard ratio = 2.0; 95% confidence interval = 0.8–4.9). Conclusion: In our cohort of children who received venoarterial extracorporeal membrane oxygenation after the Norwood procedure, hospital survival was improved compared to historical data. In addition, venoarterial extracorporeal membrane oxygenation utilization was not independently associated with worse outcomes.

Extracorporeal membrane oxygenation for pneumonitis after a Glenn palliation

Perfusion ◽  
2002 ◽  
Vol 17 (6) ◽  
pp. 457-458 ◽  
Author(s):  
James C Nielsen ◽  
Howard S Seiden ◽  
Khanh Nguyen ◽  
Susan A Vlahakis ◽  
Chitra Ravishankar
Keyword(s):  
Respiratory Syncytial Virus ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Insufficiency ◽  
Single Ventricle ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Cavopulmonary Anastomosis ◽  
Syncytial Virus ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Ecmo Therapy

A five-month old male with a single ventricle palliated with a bidirectional cavopulmonary anastomosis developed severe respiratory insufficiency from respiratory syncytial virus (RSV) pneumonitis. He was successfully rescued with extra-corporeal membrane oxygenation (ECMO) therapy and recovered with minimal morbidity.

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