Extracorporeal Membrane Oxygenation–Supported Cardiopulmonary Resuscitation Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome*

Objectives: To report on survival from a large multicenter cohort of neonates with hypoplastic left heart syndrome requiring extracorporeal membrane oxygenation–assisted cardiopulmonary resuscitation after stage 1 palliation operation. Design: Retrospective analysis of data from the Extracorporeal Life Support Organization data registry (1998 through 2013). We computed the survival to hospital discharge for neonates (age < 30 d) who required extracorporeal membrane oxygenation after stage 1 palliation and evaluated factors associated with mortality using multivariate logistic regression analysis. Setting: Multicenter data reported to Extracorporeal Life Support Organization registry. Patients: Infants with hypoplastic left heart syndrome after stage 1 palliation who received extracorporeal membrane oxygenation–assisted cardiopulmonary resuscitation. Interventions: None. Measurements and Main Results: There were 307 extracorporeal membrane oxygenation runs in the setting of extracorporeal membrane oxygenation–assisted cardiopulmonary resuscitation in 293 neonates with hypoplastic left heart syndrome following stage 1 palliation operation. The median age at cannulation was 9 days (interquartile range, 5–14 d). Survival to hospital discharge was 36%. In univariate analysis, gestational age, weight, extracorporeal membrane oxygenation duration, presence of air embolism, hemorrhagic complications, renal failure, and pulmonary complications (pulmonary hemorrhage and pneumothorax) were all associated with nonsurvival. In multivariate analysis, lower body weight at cannulation (odds ratio, 3.9; 95% CI, 1.9–8.3), duration of the extracorporeal membrane oxygenation (odds ratio, 3.4; 95% CI, 1.9–7.3), and renal failure while on extracorporeal membrane oxygenation (odds ratio, 2; 95% CI, 1.2–3.5) increased odds of mortality. Conclusions: Mortality for neonates with hypoplastic left heart syndrome supported with extracorporeal membrane oxygenation–assisted cardiopulmonary resuscitation after stage 1 palliation is high. Lower body weight, increased duration of extracorporeal membrane oxygenation support, and renal failure increased mortality.

[1]  David Wypij,et al.  Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO registry data , 2013, Intensive Care Medicine.

[2]  P. Cogo,et al.  Increased morbidity and mortality in very preterm/VLBW infants with congenital heart disease , 2013, Intensive Care Medicine.

[3]  R. Thiagarajan,et al.  Extracorporeal membrane oxygenation after stage 1 palliation for hypoplastic left heart syndrome. , 2012, The Journal of thoracic and cardiovascular surgery.

[4]  P. Kirshbom,et al.  Extracorporeal cardiopulmonary resuscitation for pediatric cardiac patients. , 2012, The Annals of thoracic surgery.

[5]  C. Robertson,et al.  Pediatric Outcomes After Extracorporeal Membrane Oxygenation for Cardiac Disease and for Cardiac Arrest: A Review , 2012, ASAIO journal.

[6]  A. D. de Caen,et al.  Pediatric ECPR: standard of care? , 2012, Resuscitation.

[7]  W. Ko,et al.  Eleven years of experience with extracorporeal cardiopulmonary resuscitation for paediatric patients with in-hospital cardiac arrest. , 2012, Resuscitation.

[8]  J. Rychik,et al.  Younger gestational age is associated with worse neurodevelopmental outcomes after cardiac surgery in infancy. , 2012, The Journal of thoracic and cardiovascular surgery.

[9]  M. Ilbawi,et al.  Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes. , 2011, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[10]  H. Dalton,et al.  Resuscitation and Extracorporeal Life Support during Cardiopulmonary Resuscitation following the Norwood (Stage 1) operation , 2011, Cardiology in the Young.

[11]  W. Jhang,et al.  The Outcome of Open Heart Surgery for Congenital Heart Disease in Infants With Low Body Weight Less Than 2500 g , 2011, Pediatric Cardiology.

[12]  D. Ross,et al.  The use of ventricular assist devices in pediatric patients with univentricular hearts. , 2011, The Journal of thoracic and cardiovascular surgery.

[13]  S. Emani,et al.  Rapid-Response Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation in Children With Cardiac Disease , 2009, Circulation.

[14]  A. Ündar,et al.  Extracorporeal Life Support Registry Report 2008: Neonatal and Pediatric Cardiac Cases , 2009, ASAIO journal.

[15]  R. Thiagarajan,et al.  Survival after extracorporeal cardiopulmonary resuscitation in infants and children with heart disease. , 2008, The Journal of thoracic and cardiovascular surgery.

[16]  R. Thiagarajan,et al.  Extracorporeal Membrane Oxygenation to Aid Cardiopulmonary Resuscitation in Infants and Children , 2007, Circulation.

[17]  R. Thiagarajan,et al.  Indication for initiation of mechanical circulatory support impacts survival of infants with shunted single-ventricle circulation supported with extracorporeal membrane oxygenation. , 2007, The Journal of thoracic and cardiovascular surgery.

[18]  M. Priestley,et al.  Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome* , 2006, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[19]  A. Hoskote,et al.  Extracorporeal life support after staged palliation of a functional single ventricle: subsequent morbidity and survival. , 2006, The Journal of thoracic and cardiovascular surgery.

[20]  G. Shirali,et al.  Incidence and outcome of cardiopulmonary resuscitation in patients with shunted single ventricle: advantage of right ventricle to pulmonary artery shunt. , 2006, The Journal of thoracic and cardiovascular surgery.

[21]  S. Hintz,et al.  Utilization and outcomes of neonatal cardiac extracorporeal life support: 1996–2000* , 2005, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[22]  T. Spray,et al.  Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation* , 2004, Critical care medicine.

[23]  P. D. del Nido,et al.  Cardiac catheterization of patients supported by extracorporeal membrane oxygenation. , 2002, Journal of the American College of Cardiology.

[24]  D. Bichell,et al.  Residual lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation support. , 2014, Journal of Thoracic and Cardiovascular Surgery.

[25]  R. Butler,et al.  Routine mechanical ventricular assist following the Norwood procedure--improved neurologic outcome and excellent hospital survival. , 2004, The Annals of thoracic surgery.