Risk factors for mortality in paediatric cardiac ICU patients managed with extracorporeal membrane oxygenation

Cardiol Young. 2019 Jan;29(1):40-47. doi: 10.1017/S1047951118001774. Epub 2018 Oct 31.


Background: Veno-arterial extracorporeal membrane oxygenation is frequently used in patients with cardiac disease. We evaluated short-term outcomes and identified factors associated with hospital mortality in cardiac patients supported with veno-arterial extracorporeal membrane oxygenation.

Methods: A retrospective review of patients supported with veno-arterial extracorporeal membrane oxygenation at a university-affiliated children's hospital was performed.

Results: A total of 253 patients with cardiac disease managed with extracorporeal membrane oxygenation were identified; survival to discharge was 48%, which significantly improved from 39% in an earlier era (1995-2001) (p=0.01). Patients were categorised into surgical versus non-surgical groups on the basis of whether they had undergone cardiac surgery before or not, respectively. The most common indication for extracorporeal membrane oxygenation was extracorporeal cardiopulmonary resuscitation: 96 (51%) in the surgical group and 45 (68%) in the non-surgical group. In a multiple covariate analysis, single-ventricle physiology (p=0.01), duration of extracorporeal membrane oxygenation (p<0.01), and length of hospital stay (p=0.03) were associated with hospital mortality. Weekend or night shift cannulation was associated with mortality in non-surgical patients (p=0.05).

Conclusion: We report improvement in survival compared with an earlier era in cardiac patients supported with extracorporeal membrane oxygenation. Single-ventricle physiology continues to negatively impact survival, along with evidence of organ dysfunction during extracorporeal membrane oxygenation, duration of extracorporeal membrane oxygenation, and length of stay.

Keywords: CHD; Paediatric; cardiac intensive care; extracorporeal membrane oxygenation; mortality.

MeSH terms

  • Cardiac Surgical Procedures / mortality*
  • Extracorporeal Membrane Oxygenation*
  • Female
  • Heart Defects, Congenital / mortality*
  • Heart Defects, Congenital / surgery*
  • Heart Ventricles / surgery
  • Hospital Mortality*
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units / statistics & numerical data
  • Logistic Models
  • Male
  • Philadelphia
  • Retrospective Studies
  • Risk Factors