Repeat Extracorporeal Membrane Oxygenation Support Is Appropriate In Selected Children With Cardiac Disease
Bahaaldin Alsoufi2, Shriprassad Deshpande1, Pranava Sinha1, Jaimin Trivedi2, Bahaaldin Alsoufi2.
1Washington National Children's Hospital, Washington, DC, USA, 2University of Louisville, Louisville, KY, USA.
Objectives: Children requiring multiple ECMO runs during same hospital admission likely have ongoing cardiac pathology (residual lesion, myocardial dysfunction) and are exposed to increased complications/end-organ dysfunction. Reported repeat ECMO survival is poor and suggested to be futile. Methods: Using ELSO data (2011-2019), We evaluated children (n=669) who received multiple (≥2) cardiac ECMO during same admission. Factors associated with hospital mortality were evaluated using multivariable regression analysis. Results: Median ECMO runs was 2(range:2-4) including 210(31%) who received extracorporeal cardiopulmonary resuscitation (ECPR). There were 250(37%) hospital survivors. Survivors were more likely older, Caucasian, and less likely to have HLHS, require >2 runs, require longer support duration, inotropes or have acidosis while on ECMO, or develop renal and neurologic complications.[TABLE]
On multivariable analysis, factors associated with death included: neonates (OR=4.7,95%CI=2.5-9.1,p<0.0001), infants (OR=2.3,95%CI=1.3-4.2,p=0.0001), Black-race (OR=2.8,95%CI=1.6-4.9,p=0.0108), persistent acidosis (pH<7.2) (OR=2.4,95%CI=1.0-5.8,p=0.0586), longer ECMO (OR=1.1,95%CI=1.06-1.12,p<0.0001, per10-hours), renal failure (OR=2.7,95%CI=1.8-4.1,p<0.0001), neurologic complications (OR=3.9,95%CI=2.2- 6.7,p<0.0001). Conclusions: In children with cardiac pathology, multiple ECMO/ECPR runs are associated with 37% hospital survival. While registry data limits ability to determine selection criteria to receive repeat ECMO, our findings suggest that in properly selected patients, repeat ECMO support is not futile. Ongoing assessment of support adequacy, end-organ function and cardiopulmonary recovery is necessary.
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