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Outcomes of Single-Ventricle Patients Supported With Extracorporeal Membrane Oxygenation

Andrew M Misfeldt1, Roxanne E Kirsch, David J Goldberg

  • 11Department of Pediatrics, the Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 2Department of Anesthesiology and Critical Care Medicine, the Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 3Department of Surgery, the Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|January 26, 2016
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) use in single-ventricle patients remains associated with high mortality and increased healthcare burden. Despite its prevalence, ECMO has not improved survival rates, with longer hospital stays and doubled charges observed.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Critical Care Medicine

Background:

  • Single-ventricle anomalies represent complex congenital heart defects often requiring advanced support.
  • Extracorporeal membrane oxygenation (ECMO) is utilized in pediatric patients with single-ventricle physiology.
  • The evolving use and outcomes of ECMO in this population warrant detailed investigation.

Purpose of the Study:

  • To describe the utilization of ECMO in pediatric patients with single-ventricle anomalies.
  • To test the hypothesis that ECMO use has increased without improved mortality.
  • To assess changes in hospital charges and length of stay associated with ECMO in single-ventricle patients.

Main Methods:

  • Retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (2000-2009).
  • Inclusion of pediatric patients (age ≤ 20) diagnosed with single ventricle heart disease requiring ECMO.
  • Sample weighting used to generate national estimates of ECMO use and outcomes.

Main Results:

  • Seven hundred one pediatric single-ventricle patients received ECMO between 2000 and 2009.
  • Overall mortality was 57% and did not significantly change over the study period.
  • Length of stay increased from 25.2 to 55.6 days, and inflation-adjusted charges doubled, exceeding $732,000.

Conclusions:

  • ECMO support for single-ventricle patients is infrequent, occurring in 2.3% of hospitalizations.
  • Mortality remains high at 57% with no improvement over time.
  • Acute renal failure emerged as an independent risk factor for mortality, alongside increased length of stay and hospital costs.
Abstract

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