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Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
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Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting

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Predictors of ECMO support in infants with tachycardia-induced cardiomyopathy

Jack Christian Salerno1, Stephen Paul Seslar, Terrence Ung Hoong Chun

  • 1Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA 98105-0371, USA.

Pediatric Cardiology
|March 31, 2011
PubMed

Insights

Tachycardia-induced cardiomyopathy (TIC) in infants can be severe. Infants with supraventricular tachycardia (SVT) and TIC showing a left ventricular end diastolic z-score over 2 may require extracorporeal membrane oxygenation (ECMO) support.

Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine

Background:

  • Tachycardia-induced cardiomyopathy (TIC) development correlates with supraventricular tachycardia (SVT) rate and duration.
  • Infants are vulnerable to TIC due to potentially unrecognized early symptoms.
  • Extracorporeal membrane oxygenation (ECMO) can improve outcomes in SVT with TIC, but predictors for its use are unknown.

Purpose of the Study:

  • To identify clinical predictors for extracorporeal membrane oxygenation (ECMO) requirement in infants diagnosed with SVT and TIC.

Main Methods:

  • Retrospective analysis of 16 infants (<6 months) with resolved TIC after arrhythmia control.
  • Comparison of clinical characteristics between infants requiring ECMO and those managed medically.
  • Assessment of M-mode-derived left ventricular end diastolic dimension (LVED) z-scores.

Main Results:

  • 19% (3/16) of infants required ECMO support.
  • No significant differences in age, SVT type, SVT rate, or ventricular dysfunction between groups.
  • Infants needing ECMO had a significantly higher median LVED z-score (+2.8) compared to medically managed infants (0.0, P=0.009).
  • A LVED z-score >2.3 was not observed in the medically managed group.

Conclusions:

  • Infants with SVT and TIC presenting with an LVED z-score >2 are at higher risk for requiring ECMO.
  • Early consideration of ECMO support is recommended for these high-risk infants.

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