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Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation*

Morris, Marilyn C. MD; Ittenbach, Richard F. PhD; Godinez, Rodolfo I. MD, PhD; Portnoy, Joel D. MD; Tabbutt, Sarah MD, PhD; Hanna, Brian D. MD, PhD; Hoffman, Timothy M. MD; Gaynor, J. William MD; Connelly, James T. RRT; Helfaer, Mark A. MD; Spray, Thomas L. MD; Wernovsky, Gil MD

doi: 10.1097/01.CCM.0000119425.04364.CF
PEDIATRIC CRITICAL CARE
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Objective To identify factors associated with mortality in children with heart disease managed with extracorporeal membrane oxygenation (ECMO).

Design Retrospective chart review.

Setting Tertiary care university-affiliated children’s hospital.

Patients All pediatric cardiac intensive care unit patients managed with ECMO between January 1, 1995, and June 30, 2001.

Interventions None.

Results During the study period, 137 patients were managed with ECMO in the pediatric cardiac intensive care unit. Of the 137 patients, 80 (58%) survived ≥24 hrs after decannulation, and 53 (39%) survived to hospital discharge. Patients managed with ECMO following cardiac surgery were analyzed separately from patients not in the postoperative period. Factors associated with an increased probability of mortality in the postoperative patients were age <1 month, male gender, longer duration of mechanical ventilation before ECMO, and development of renal or hepatic dysfunction while on ECMO. Single ventricle physiology and failure to separate from cardiopulmonary bypass were not associated with an increased risk of mortality. Cardiac physiology and indication for ECMO were not associated with mortality rate. Although longer duration of ECMO was not associated with increased mortality risk, patients with longer duration of ECMO were less likely to survive without heart transplantation.

Conclusions In a series of 137 patients managed with ECMO in a pediatric cardiac intensive care unit, survival to hospital discharge was 39%. In postoperative patients only, mortality risk was increased in males, patients <1 month old, patients with a longer duration of mechanical ventilation before initiation of ECMO, and patients who developed renal or hepatic failure while on ECMO.

From The Children’s Hospital of Philadelphia, Department of Anesthesia and Critical Care Medicine (MCM, RIG, JDP, ST, MAH), Department of Biostatistics (RFI), Department of Pediatrics (ST, BDH, TMH, GW), Department of Surgery (JWG, TLS), and Department of Nursing (JTC).

In a series of 137 patients managed with extracorporeal membrane oxygenation in a pediatric cardiac intensive care unit, survival to hospital discharge was 39%.

© 2004 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins