First name
Roxanne
Middle name
E
Last name
Kirsch

Title

Outcomes of Single-Ventricle Patients Supported With Extracorporeal Membrane Oxygenation.

Year of Publication

2016

Number of Pages

194-202

Date Published

2016 Mar

ISSN Number

1529-7535

Abstract

<p><strong>OBJECTIVES: </strong>Extracorporeal membrane oxygenation is often used in children with single-ventricle anomalies. We aimed to describe extracorporeal membrane oxygenation use in single-ventricle patients to test the hypothesis that despite increasing prevalence, mortality has not improved and overall burden measure by hospital charges and length of stay have increased.</p>

<p><strong>DESIGN: </strong>Retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed with sample weighting to generate national estimates.</p>

<p><strong>PATIENTS: </strong>Pediatric patients (age ≤ 20) with a diagnosis of single ventricle heart disease requiring extracorporeal membrane oxygenation support from 2000 to 2009.</p>

<p><strong>INTERVENTIONS: </strong>None.</p>

<p><strong>MEASUREMENTS AND MAIN RESULTS: </strong>Seven hundred one children (95% CI, 559-943) with single ventricle were supported with extracorporeal membrane oxygenation in the reporting period. Mortality was 57% and did not improve over time (2000 = 52%, 2003 = 63%, 2006 = 57%, and 2009 = 55%; p = 0.66). Single-ventricle patients who required extracorporeal membrane oxygenation were more likely to have had a cardiac procedure (90% vs 46%; p &lt; 0.001), a diagnosis of arrhythmia (22% vs 13%; p &lt; 0.001), cerebrovascular or neurologic insult (9% vs 1%; p &lt; 0.001), heart failure (24% vs 12%; p &lt; 0.001), acute renal failure (28% vs 3%; p &lt; 0.001), or sepsis (28% vs 8%; p &lt; 0.001). By multivariable analysis, acute renal failure was a risk factor for mortality (adjusted odds ratio, 3.12; 95% CI, 1.95-4.98; p &lt; 0.001). The length of stay for single-ventricle patients with extracorporeal membrane oxygenation increased from 25.2 days in 2000 to 55.6 days in 2009 (p &lt; 0.001). Total inflation-adjusted charges increased from $358,021 (95% CI, $278,658-439,765) in 2000 to $732,349 (95% CI, $671,781-792,917) in 2009 (p &lt; 0.001).</p>

<p><strong>CONCLUSIONS: </strong>Extracorporeal membrane oxygenation support is uncommon with single-ventricle admissions occurring in 2.3% of all hospitalizations. Among those patients, the mortality rate was 57% with no change over time. Acute renal failure was an independent risk factor for mortality during hospitalization. In addition, length of stay for these patients increased and hospital charges doubled. Further studies are needed to determine suitability and cost-effectiveness of extracorporeal membrane oxygenation in single-ventricle patients.</p>

DOI

10.1097/PCC.0000000000000616

Alternate Title

Pediatr Crit Care Med

PMID

26808622

Title

Clinical Issues and Controversies in Heart Failure and Transplantation.

Year of Publication

2016

Number of Pages

63-71

Date Published

2016 Jan

ISSN Number

2150-136X

Abstract

<p>Heart failure is a common problem among children admitted in the intensive care unit and is associated with significant morbidity and mortality. As such, the 2014 meeting of the Pediatric Cardiac Intensive Care Society included a session on Clinical Controversies in Heart Failure and Transplantation. This review contains the summaries of the podium presentations of this session and will cover some of the challenging aspects of caring for these patients including medical and mechanical support, fluid overload states, high-risk populations including those after heart transplantation, and end-of-life considerations.</p>

DOI

10.1177/2150135115606622

Alternate Title

World J Pediatr Congenit Heart Surg

PMID

26714996

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