Characterization of ECMO Support for Single-Ventricle Patients
Elizabeth H. Stephens, Aqsa Shakoor, MD, Shimon E. Jacobs, MD, Shunpei Okochi, MD, Ariela Zenilman, MD, William Middlesworth, MD, Damien J. LaPar, MS, MD, Paul Chai, MD, David Kalfa, MD, PhD, Emile Bacha, MD, Eva W. Cheung, MD.
Columbia University, New York, NY, USA.
Objective(s): Extracorpeal membrane oxygenation (ECMO) can provide crucial support for single ventricle patients. However, the utilization and outcomes of ECMO in these patients remains incompletely studied.
Methods: We retrospectively reviewed single ventricle patients supported by ECMO between 1/2010-12/2017 with primary end-point of survival to discharge and secondary endpoint of survival to decannulation with or without heart transplantation. Multi-variate analysis was performed for factors predictive of survival to discharge and survival to decannulation.
Results: Forty single ventricle patients received ECMO support (see Table). Twenty-seven patients (68%) survived to decannulation with or without heart transplantation, and twenty-one patients (53%) of the entire cohort survived to discharge. Complications included infection (40%), bleeding (40%), thrombosis (33%), and stroke (45%). Factors associated with survival to decannulation included pre-ECMO lactate (hazard ratio (HR): 0.61, 95% CI: 041-0.90, p=0.013) and post-ECMO bicarbonate (HR: 1.24, 95% CI: 1.0-1.5, p=0.018). Factors associated with no survival to discharge included central cannulation (HR: 0.03, 95% CI: 0.002-0.319, p=0.005) and thrombotic complications (HR: 28.7, 95% CI: 2.1-382.9, p=0.011). Compared to Norwood-Sano, Norwood-BTS patients were more likely to undergo ECMO cannulation during CPR (88% vs 27%, p=0.009) and to have moderately-severe ventricular dysfunction (50% vs, 7%, p=0.002).
Conclusions: ECMO can be effective in supporting single ventricle patients with half surviving to discharge. Complications are not infrequent and further studies are required to improve patient outcomes.
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