Open Access

ARTICLE

Predictors of extracorporeal membrane oxygenation support after surgery for adult congenital heart disease in children’s hospitals

by

1 Division of Cardiology, Seattle Children’s Hospital, Seattle, Washington
2 Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
3 Division of Cardiology, Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington
4 Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
5 Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
6 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
7 Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
8 Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
9 Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington

* Corresponding Author: Stephen J. Dolgner, Seattle Children’s Hospital, RC.2.820 PO Box 5371, Seattle, WA 98145‐5005. Email:

Congenital Heart Disease 2019, 14(4), 559-570. https://doi.org/10.1111/chd.12758

Abstract

Objective: Adult congenital heart disease (ACHD) patients who undergo cardiac surgery are at risk for poor outcomes, including extracorporeal membrane oxygenation support (ECMO) and death. Prior studies have demonstrated risk factors for mortality, but have not fully examined risk factors for ECMO or death without ECMO (DWE). We sought to identify risk factors for ECMO and DWE in adults undergoing congenital heart surgery in tertiary care children’s hospitals.
Design: All adults (≥18 years) undergoing congenital heart surgery in the Pediatric Health Information System (PHIS) database between 2003 and 2014 were included. Patients were classified into three groups: ECMO‐free survival, requiring ECMO, and DWE. Univariate analyses were performed, and multinomial logistic regression models were constructed examining ECMO and DWE as independent outcomes.
Setting: Tertiary care children’s hospitals.
Results: A total of 4665 adult patients underwent ACHD surgery in 39 children’s hospitals with 51 (1.1%) patients requiring ECMO and 64 (1.4%) patients experiencing DWE. Of the 51 ECMO patients, 34 (67%) died. Increasing patient age, surgical complexity, diagnosis of single ventricle heart disease, preoperative hospitalization, and the presence of noncardiac complex chronic conditions (CCC) were risk factors for both outcomes. Additionally, low and medium hospital ACHD surgical volume was associated with an increased risk of DWE in comparison with ECMO.
Conclusions: There are overlapping but separate risk factors for ECMO support and DWE among adults undergoing congenital heart surgery in pediatric hospitals.

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