Long-Term Outcomes of Pediatric Cardiac Patients Supported by Extracorporeal Membrane Oxygenation. Issue 8 (August 2017)

• Record Type: Journal Article
• Authors: Elias, Matthew D.; Achuff, Barbara-Jo; Ittenbach, Richard F.; Ravishankar, Chitra; Spray, Thomas L.; Fuller, Stephanie; Montenegro, Lisa M.; Gaynor, J. William; O'Connor, Matthew J.
• Is Part Of: Pediatric critical care medicine. Volume 18:Issue 8(2017)
• Publication Date: 2017-08
• Subjects: cardiac -- congenital heart disease -- extracorporeal membrane oxygenation -- pediatrics -- quality of life; Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000001227
• Languages: English
• ISSNs: 1529-7535

Abstract

Abstract : Objective: Extracorporeal membrane oxygenation is an important form of short-term mechanical support in children with cardiac disease, but information on long-term outcomes and quality of life is limited. The primary objective of this study was to determine the long-term outcomes of children previously supported by extracorporeal membrane oxygenation for cardiac etiologies. Design: A retrospective analysis was performed on patients with cardiac disease managed with extracorporeal membrane oxygenation between January 1, 1995, and December 31, 2012, at the Children's Hospital of Philadelphia. Survivors completed patient- and parent-reported verbal and written surveys, and univariate analyses assessed risk factors for long-term outcomes. Setting: Tertiary-care children's hospital. Patients: Patients with cardiac disease managed with extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: Over 18 years, 396 patients were managed with extracorporeal membrane oxygenation with 43% survival to discharge. The median age at cannulation was 78 days. The majority had congenital heart disease (86%), surgery prior to extracorporeal membrane oxygenation (71%), and cardiopulmonary arrest as the primary extracorporeal membrane oxygenation indication (53%). With 6-year median follow-up, 66% are known to be deceased, including 38 deaths after hospital discharge. Among survivors at discharge, 65 (38%) completed the phone survey, and 33 (19%) completed the written survey. Negative clinical outcomes, defined as having at least significant physical limitations or "fair" or "poor" health, were present in 18% of patients. No patient- or extracorporeal membrane oxygenation–related variables were associated with negative outcomes in univariate analyses. There were significantly lower self-reported and parent-reported written Pediatric Quality of Life Inventory quality of life scores in children compared with healthy individual normative data but no differences in adolescents. Conclusions: In this series of pediatric cardiac patients supported by extracorporeal membrane oxygenation, mortality was 66% with 6-year median follow-up. The majority reported positive outcomes with respect to health and physical limitations, but children reported lower quality of life compared with healthy individuals.