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Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Extended survival and re-hospitalisation among paediatric patients requiring extracorporeal membrane oxygenation for
Nicole Erwin1, Jeannie Zuk, Jon Kaufman
1Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, School of Medicine, University of Colorado at Denver, 13120 East 16th Avenue, Aurora, CO 80045, United States of America.
Insights
Pediatric patients on extracorporeal membrane oxygenation (ECMO) for cardiac failure show encouraging survival. However, most survivors require re-hospitalization, often for cardiac issues, highlighting the need for long-term follow-up.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Survival rates for pediatric patients on extracorporeal membrane oxygenation (ECMO) for cardio-circulatory failure are documented.
- Extended survival and re-hospitalization data for these patients remain limited in the literature.
Purpose of the Study:
- To describe extended survival and re-hospitalization rates in pediatric patients who received ECMO for primary cardiac dysfunction.
- To evaluate the need for subsequent cardiac surgeries in this cohort.
Main Methods:
- Retrospective review of pediatric patients undergoing ECMO for primary cardiac dysfunction over a 5-year period.
- Analysis of patient data including survival to discharge, re-hospitalization rates, and need for further cardiac surgery.
- Median follow-up of 5.4 years post-discharge.
Main Results:
- 37% of patients survived to hospital discharge.
- 88% of hospital survivors were re-hospitalized, with 63% for cardiac indications.
- 38% of patients required additional cardiac surgery post-ECMO.
Conclusions:
- Pediatric cardiac ECMO survivors demonstrate promising long-term survival.
- Re-hospitalization is frequent within the first year, often for cardiac reasons.
- Further cardiac interventions are common, necessitating long-term quality-of-life assessments.
Background:
Although survival to hospital discharge among children requiring extracorporeal membrane oxygenation support for medical and surgical cardio-circulatory failure has been reported in international registries, extended survival and re-hospitalisation rates have not been well described in the literature.
Material And Methods:
This is a single-institution, retrospective review of all paediatric patients receiving extracorporeal membrane oxygenation for primary cardiac dysfunction over a 5-year period.
Results:
A total of 74 extracorporeal membrane oxygenation runs in 68 patients were identified, with a median follow-up of 5.4 years from hospital discharge. Overall, 66% of patients were decannulated alive and 25 patients (37%) survived to discharge. There were three late deaths at 5 months, 20 months, and 6.8 years from discharge. Of the hospital survivors, 88% required re-hospitalisation, with 63% of re-admissions for cardiac indications. The median number of hospitalisations per patient per year was 0.62, with the first re-admission occurring at a mean time of 9 months after discharge from the index hospitalisation. In all, 38% of patients required further cardiac surgery.
Conclusions:
Extended survival rates for paediatric hospital survivors of cardiac extracorporeal membrane oxygenation support for medical and post-surgical indications are encouraging. However, re-hospitalisation within the first year following hospital discharge is common, and many patients require further cardiac surgery. Although re-admission hospital mortality is low, longer-term follow-up of quality-of-life indicators is required
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