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Extracorporeal Membrane Oxygenation in Single Ventricle Lesions Palliated Via the Hybrid Approach
Peter P Roeleveld1, Rob de Wilde2, Mark Hazekamp3
1Pediatric Intensive Care, Leiden University Medical Center, the Netherlands p.p.roeleveld@lumc.nl.
Insights
Survival for hypoplastic left heart syndrome (HLHS) patients needing extracorporeal membrane oxygenation (ECMO) after hybrid palliation is very low (16%). These poor outcomes for HLHS patients require further investigation to improve care.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiothoracic Surgery
Background:
- Hypoplastic left heart syndrome (HLHS) is a complex congenital heart defect.
- Hybrid palliation involves pulmonary artery banding and stenting the patent ductus arteriosus.
- Extracorporeal membrane oxygenation (ECMO) is used for cardiorespiratory support.
Purpose of the Study:
- To describe outcomes for children with HLHS undergoing hybrid palliation requiring ECMO.
- To report survival rates and ECMO complications in this patient population.
Main Methods:
- Retrospective review of the Extracorporeal Life Support Organization database.
- Inclusion of patients with HLHS undergoing hybrid stage 1 or post-stage 2 palliation with ECMO.
- Data analysis focused on survival to hospital discharge and ECMO complications.
Main Results:
- 44 HLHS patients required ECMO after stage 1 hybrid palliation.
- Median age at ECMO cannulation was 13.5 days.
- Only 16% survived to hospital discharge; 50% experienced cardiac arrest before ECMO initiation.
Conclusions:
- Overall survival for HLHS patients on ECMO after hybrid palliation is poor (16%).
- This survival rate is lower than reported for ECMO after conventional stage 1 palliation.
- Further research is needed to understand and improve these outcomes.
Background:
Describing outcomes for children with hypoplastic left heart syndrome (HLHS) undergoing hybrid palliation (pulmonary artery band and stent placement in the patent ductus arteriosus) requiring extracorporeal membrane oxygenation (ECMO) support for cardiorespiratory failure.
Methods:
We reviewed the Extracorporeal Life Support Organization database for all patients with a diagnosis of an HLHS undergoing hybrid stage 1 palliation supported with ECMO and those patients with hybrid palliation supported with ECMO after comprehensive stage 2 palliation. Patients were identified using a combination of International Classification of Diseases, Ninth Revision and registry diagnosis and procedure codes. We report survival to hospital discharge and ECMO complications.
Results:
We identified 44 patients with HLHS requiring ECMO following stage 1 hybrid approach. Median age at cannulation was 13.5 days. Only 16% survived to hospital discharge. In all, 20 (50%) patients had a cardiac arrest prior to going onto ECMO and for 3 (19%) patients, ECMO was initiated during cardiopulmonary resuscitation.
Conclusions:
Overall survival for ECMO support in patients with HLHS palliated via the hybrid approach is very poor (16%) and is worse than 31% survival reported for ECMO after conventional stage 1 palliation. The reasons for these poor outcomes require further investigation.
