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Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery
Nikoleta S Kolovos1, Susan L Bratton, Frank W Moler
1Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
Insights
Extracorporeal life support (ECLS) in pediatric cardiac surgery patients shows improved survival with two-ventricle repair. Hemofiltration use on ECLS significantly increases mortality risk.
Area of Science:
- Pediatric Cardiac Surgery
- Extracorporeal Life Support (ECLS)
- Critical Care Medicine
Background:
- Extracorporeal life support (ECLS) is a critical intervention for select pediatric patients post-cardiac surgery.
- Previous studies identified mortality factors in this population.
- This study reassesses recent ECLS outcomes and associated factors.
Purpose of the Study:
- To evaluate clinical features impacting survival in pediatric patients receiving ECLS post-cardiac surgery.
- To compare current outcomes with prior experience and identify changes in practice.
- To identify predictors of mortality in this high-risk group.
Main Methods:
- Retrospective analysis of pediatric patients (July 1995-June 2001) requiring ECLS within 7 days of surgery.
- Comparison of survival rates based on patient demographics, cannulation site, indication, and interventions.
- Multivariate analysis to identify independent predictors of mortality.
Main Results:
- Fifty percent of the 74 studied patients survived to discharge.
- Hemofiltration during ECLS was associated with significantly lower survival (23% vs. 65%).
- Multivariate analysis revealed hemofiltration increased mortality risk fivefold (OR 5.01).
- Adequate two-ventricle repair was associated with a lower risk of death (OR 0.42).
Conclusions:
- Patients with adequate two-ventricle repair demonstrate significantly higher hospital survival rates.
- Single ventricle physiology and the need for dialysis (hemofiltration) are associated with decreased survival on ECLS.
- These findings highlight the importance of ventricular repair strategy and renal support considerations in ECLS management.
Background:
Extracorporeal life support (ECLS) has been used for over two decades in select patients after cardiac surgery. We previously described factors associated with death in this population. We now review our recent experience to reassess factors related to mortality.
Methods:
All pediatric patients who received ECLS support within 7 days after surgery between July 1995 and June 2001 were examined to describe clinical features associated with survival. We compared the results with our prior report to assess changes in practice and outcome.
Results:
Seventy-four patients were followed. Fifty percent survived to discharge. Hospital survival was not significantly related to patient age, cannulation site, or indication. Thirty-five percent of patients required hemofiltration while on ECLS and were significantly less likely to survive (23% vs 65%). A multivariate analysis combining all children from our prior report with the present cohort revealed that patients who received hemofiltration were five times more likely to die (odds ratio 5.01, 95% confidence interval 2.11-11.88). Children with an adequate two-ventricular repair had lower risk of death (odds ratio 0.42, 95% confidence interval 0.19-0.91) after adjusting for patient age, study period, and hours elapsed before initiation of ECLS after surgery.
Conclusions:
Patients with an adequate two-ventricle repair have significantly higher hospital survival, whereas those with single ventricle physiology or need for dialysis have decreased survival.
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