Abstract 20424: Extracorporeal Membrane Oxygenation (ECMO) Support in Single Ventricle Patients After the Glenn Procedure: Review of the Extracorporeal Life Support Organization (ELSO) Registry
Introduction: ECMO support has been used for both acquired and complex congenital cardiac disease. Despite additional technical challenges, there has been an increase in the use of ECMO for complex congenital cardiac patients with single ventricle physiology. While few reports have been published on the use of ECMO following the Norwood or Fontan operations, only case series on its use following the Glenn shunt exist.
Methods: Data was collected from the ELSO Registry for patients with a Glenn shunt supported with ECMO from 1990-2012. Demographics, survival, and data pertaining to ECMO support were obtained. Descriptive statistics and multivariate analyses utilizing Mann-Whitney U, chi-square, or Fisher’s exact tests were performed to identify associations with mortality.
Results: Two hundred twenty nine patients with bidirectional or classic Glenn shunts had ECMO performed at a median age of 5.9 months [4.4, 8.8]. Hospital survival was 33%. Primary indications were cardiac for 162 patients (71%), respiratory for 27 (12%) and ECPR for 40 (17%). Survival was 33% for cardiac, 37% for respiratory and 30% for ECPR indications. Univariate analysis demonstrated pre-ECMO variables of lower weight (5.8 kg versus 6.2 kg; p = 0.03), elevated PaCO2 (55 mmHg versus 44 mmHg; p < 0.005), lower PaO2 (32 mmHg versus 37 mmHg; p = 0.05), use of bicarbonate (p = 0.02), and longer duration of intubation (34 hours versus 15 hours; p = 0.003) as significant associations with mortality. ECMO variables significantly associated with mortality were elevated oxygen concentrations (0.4 versus 0.35; p = 0.03), longer duration of ECMO support (151 hours versus 91 hours; p < 0.001), circuit complications (p = 0.005), neurologic complications (p = 0.05), and renal injury (p < 0.001). Multivariate analysis demonstrated only elevated pre-ECMO PaCO2 (OR 1.022, 95% CI 1.01-1.04; p = 0.008) and renal injury (OR 2.51, 95% CI 1.15-5.53; p < 0.001) as significant associations with mortality.
Conclusion: Despite the challenges presented by complex anatomy, patients following the Glenn shunt for single ventricular physiology can be supported successfully, though overall survival is less than the general population. Hypercarbia prior to ECMO and renal injury were associated with increased mortality.
- Congenital heart disease
- Extracorporeal circulation
- Congenital heart surgery
- Single ventricle
- Pediatric cardiac intensive care
Author Disclosures: S.I. Aydin: None. M. Duffy: None. D. Rodriguez: None. R.R. Thiagarajan: None. S. Weinstein: None.
- © 2014 by American Heart Association, Inc.