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Ventricular Arrhythmias During Extracorporeal Circulatory Support for Cardiac Indications: Outcomes in a
William F Patten1, Eric S Silver1, Eva W Cheung1,2
1Department of Pediatrics, Division of Pediatric Cardiology, NewYork-Presbyterian-Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY.
Insights
Arrhythmias occurred in one-third of pediatric cardiac ECMO runs, with ventricular arrhythmias significantly increasing the risk of death, heart transplant, and ECMO failure. These findings highlight the importance of monitoring arrhythmias in pediatric patients on ECMO.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Venoarterial extracorporeal membrane oxygenation (ECMO) is a vital support for pediatric patients with severe heart failure.
- Arrhythmias are a known risk in these patients, but their prevalence and impact during ECMO are not well-defined.
Purpose of the Study:
- To investigate the incidence and types of arrhythmias in pediatric patients undergoing venoarterial ECMO for cardiac failure.
- To determine the association between arrhythmias and adverse outcomes, including mortality, heart transplantation, and ECMO wean failure.
Main Methods:
- Retrospective cohort study conducted at a single quaternary care center from 2020 to 2023.
- Included pediatric patients requiring venoarterial ECMO for cardiac indications.
- Analyzed data on arrhythmia occurrence and its correlation with clinical outcomes.
Main Results:
- Arrhythmias were observed in 33% of ECMO runs, with ventricular arrhythmias in 17%.
- Ventricular arrhythmias were significantly associated with an increased hazard of death or heart transplantation (HR, 5.7) and ECMO wean failure (HR, 18.8).
- Any arrhythmia correlated with longer ECMO duration, particularly ventricular arrhythmias.
Conclusions:
- Arrhythmias are common during pediatric cardiac ECMO, affecting one in three patients.
- Ventricular arrhythmias pose a substantial risk for adverse outcomes, including transplant-free survival, ECMO wean failure, and prolonged support duration.
- Close monitoring and management of arrhythmias are crucial for improving outcomes in pediatric ECMO patients.
Objectives:
Venoarterial extracorporeal membrane oxygenation (ECMO) can be used for pediatric patients in heart failure because of congenital or acquired heart disease. Even though these patients are at risk of arrhythmias, data are limited regarding the prevalence and types of arrhythmias, and their association with adverse outcomes. We present our single-center experience of arrhythmia during pediatric cardiac ECMO support, and the associated outcomes.
Design:
Single-center, retrospective cohort, 2020-2023.
Setting:
Cardiac ICU in a quaternary care center in New York.
Patients:
Pediatric patients requiring ECMO for cardiac indications, including extracorporeal cardiopulmonary resuscitation, cardiogenic shock, hypoxemia secondary to lack of pulmonary blood flow, or inability to wean from cardiopulmonary bypass.
Interventions:
None.
Measurements And Main Results:
We identified 74 patients undergoing 83 ECMO runs during 2020-2023. Arrhythmias occurred in 27 of 83 ECMO runs (33% [95% CI, 23-44%]), including ventricular arrhythmias in 14 of 83 runs (17%). We did not identify an association between any arrhythmia while on ECMO support and death or heart transplantation. However, ventricular arrhythmias were associated with greater hazard (using hazard ratio [HR]) of death or heart transplantation (HR, 5.7 [95% CI, 1.2-27.8]; p = 0.03). Similarly, we failed to identify an association between any arrhythmia on ECMO and wean failure ( p = 0.09); however, ventricular arrhythmias on ECMO were associated with greater hazard of wean failure (HR, 18.8 [95% CI, 2.9-121]; p = 0.002). Any arrhythmia on ECMO was also associated with longer ECMO duration (189 vs. 90.1 hr; p < 0.001), particularly ventricular arrhythmias (335 vs. 94 hr; p < 0.001).
Conclusions:
In our 2020-2023, single-center experience in pediatric cardiac cases requiring venoarterial ECMO support for cardiac failure, the prevalence of arrhythmias was substantial (one-in-three ECMO runs). Of note, ventricular arrhythmias on ECMO were associated with greater hazard of transplant-free survival, ECMO wean failure, and prolonged ECMO duration.
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