Abstract 17701: Factors Influencing Survival to Hospital Discharge amongst Neonates Requiring Extracorporeal Membrane Oxygenation for Cardiac Indications
Background: Survival in neonates supported with ECMO for cardiac indications is poor. The most recent Extracorporeal Life Support Organization’s (ELSO) data registry report reveals survival to hospital discharge is 39% amongst neonates cannulated for cardiac indications. Although previous single center studies have identified risk factors for survival, a comprehensive multivariate analysis of factors associated with survival for this population is not available. Because a clear understanding of factors associated with survival may help design treatment strategies to improve outcomes in this cohort, we evaluated factors associated with survival in neonates supported with ECMO for cardiac indications.
Methods: In this retrospective multi-center cohort study using the ELSO registry, all neonates (<30 days of age) with an underlying cardiac diagnosis who were cannulated for ECMO between 2001-2011 were included. A multivariate analysis was performed to analyze the relationship between demographic factors, complexity of pre-ECMO surgical procedures, and ECMO factors and mortality prior to hospital discharge.
Results: Of 4,471 neonates cannulated for cardiac indications, 1832 (41%) neonates survived to hospital discharge. Patients who died prior to hospital discharge were more likely to have lower body weight, be of younger gestational age, undergone ECMO during earlier era, and have lower pH at time of cannulation. In multivariable analysis, death prior to hospital discharge was associated with lower body weight at time of cannulation (weight < 2.5 kg, OR=3.9, 95% CI = 2.49, 4.35), duration of ventilation prior to cannulation (≥72 hours from time of intubation to ECMO, OR = 1.65, 95% CI = 1.39, 1.96), ECMO duration (≥174 hours on ECMO, OR = 3.46, 95% CI = 2.79, 4.29) and surgical RACHS-1 category of 6 (OR 1.32, 95% CI = 1.14, 1.52).
Conclusions: Lower body weight at time of ECMO cannulation, longer duration of ventilation prior to cannulation, longer ECMO duration, and surgical RACHS-1 category of 6 were found to be significant risk factors for mortality prior to hospital discharge amongst neonates cannulated to ECMO for cardiac indications. Better patient selection for ECMO support may help improve ECMO outcomes in this population.
- © 2012 by American Heart Association, Inc.