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Children 2017, 4(11), 101; doi:10.3390/children4110101

Factors Associated with the Need for, and the Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital Heart Disease during Admissions for Cardiac Surgery

1
Department of Pediatrics, Chicago Medical School, 3333 North Green Bay Road, North Chicago, IL 60064, USA
2
Cincinnati Children’s Hospital, Division of Pediatric Cardiology, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
*
Author to whom correspondence should be addressed.
Received: 8 August 2017 / Revised: 2 November 2017 / Accepted: 15 November 2017 / Published: 22 November 2017
(This article belongs to the Section Pediatric Surgery)
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Abstract

Introduction: This study aimed to determine factors associated with the need for extracorporeal membrane oxygenation (ECMO) in children with congenital heart disease (CHD) during admission for cardiac surgery (CS). A secondary aim was to determine how ECMO impacted length, cost, and mortality of the admission. Methods: Data from the Kids’ Inpatient Database (KIDS) were utilized. Admissions with CHD under 18 years of age with cardiac surgery were included. Need for ECMO in these admissions was then identified. Univariate analysis was conducted to compare characteristics between admissions with and without ECMO. Regression analyses were conducted to determine what factors were independently associated with ECMO and whether ECMO independently impacted admission characteristics. Results: A total of 46,176 admissions with CHD and CS were included in the final analysis. Of these, 798 (1.7%) required ECMO. Median age of ECMO admissions was 0.5 years. The following were associated with ECMO: decreased age, heart failure, acute kidney injury, arrhythmia, double outlet right ventricle, atrioventricular septal defect, transposition, Ebstein anomaly, hypoplastic left heart syndrome, common arterial trunk, tetralogy of Fallot, coronary anomaly, valvuloplasty, repair of total anomalous pulmonary venous connection, arterial switch, RV to PA conduit placement, and heart transplant (p < 0.01). ECMO independently increased length of stay by 17.8 days, cost of stay by approximately $415,917, and inpatient mortality 22-fold. Conclusion: Only a small proportion of CHD patients undergoing CS require ECMO, although these patients require increased resource utilization and have high mortality. Specific cardiac lesions, cardiac surgeries, and comorbidities are associated with increased need for ECMO. View Full-Text
Keywords: pediatrics; children; extracorporeal membrane oxygenation; congenital heart disease; risk factors; mortality; life support pediatrics; children; extracorporeal membrane oxygenation; congenital heart disease; risk factors; mortality; life support
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Aiello, S.; Loomba, R.S. Factors Associated with the Need for, and the Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital Heart Disease during Admissions for Cardiac Surgery. Children 2017, 4, 101.

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