Abstract 16801: Factors Associated With Mortality for Infants Requiring Postoperative Extracorporeal Membrane Oxygenation Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome
Background: Patients with hypoplastic left heart syndrome (HLHS) undergoing stage 1 palliation (S1P) comprise a large percentage of patients supported with extracorporeal membrane oxygenation (ECMO) for postoperative cardiopulmonary failure. We report survival to hospital discharge in a large cohort of HLHS patients who required ECMO support following S1P, and analyze factors associated with mortality.
Methods: All neonates who underwent S1P for HLHS, required postoperative ECMO support, and were reported to the Extracorporeal Life Support Organization (ELSO) Registry during 2000 - 2009 were included. Survival to hospital discharge was computed. Factors associated with hospital mortality were assessed using multivariable logistic regression analysis.
Results: Among 738 neonates with HLHS who underwent postoperative ECMO support following S1P (762 runs; 25% of neonatal cardiac ECMO runs), overall survival was 31%. Median age at ECMO was 7 days (IQR 4, 11), weight 3 kg (IQR 2.7, 3.4), and time from surgery to cannulation 11 hr (IQR 6, 22). Median ECMO support duration was 103 hr (IQR 61, 168). There was no increase in survival (p=0.2) despite increased utilization of ECMO (p=0.02) over the study period. In multivariate modeling, black race (OR 2.5; 95% CI 1.3, 4.5), duration of ventilation prior to ECMO > 15 hrs (OR 1.8; CI 1.2, 2.7), failure to wean from bypass (OR 1.6; CI 1.03, 2.5), use of positive end expiratory pressure > 6 cm H2O (OR 1.7; CI 1.1, 2.8), and longer duration of ECMO (per day, OR 1.22; CI 1.2, 1.27) increased mortality odds. ECMO complications including renal failure (OR 1.8; CI 1.1, 3.1), use of renal replacement therapy (OR 2.2; CI 1.1, 4.3), inotrope requirement (OR 1.6; CI 1.1, 2.2), respiratory complications (OR 9.1; CI 1.2, 69.5), and neurological injury (OR 2.1; CI 1.3, 3.5) increased mortality odds.
Conclusions: ECMO is increasingly used to support S1P HLHS patients, however mortality remains high. Although we identified few factors to help guide patient selection, those who require longer duration of ventilation prior to ECMO, fail to wean off of bypass intraoperatively, or have significant ECMO complications have higher odds of mortality. Careful conduct of EMCO to limit complications and protect end-organ function may help improve survival.
- © 2010 by American Heart Association, Inc.