Cardiology in the Young

Original Article

Extended survival and re-hospitalisation among paediatric patients requiring extracorporeal membrane oxygenation for primary cardiac dysfunction

Nicole Erwina1, Jeannie Zuka2, Jon Kaufmana3, Zhaoxing Pana4, Esther Carpentera5, Max B. Mitchella6 and Eduardo M. da Cruza7 c1

a1 School of Medicine, Anschutz Medical Campus, The University of Colorado, Colorado, United States of America

a2 Department of Anesthesiology, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America

a3 Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America

a4 The Research Institute, University of Colorado, Colorado, United States of America

a5 Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America

a6 Pediatric Cardiac Surgery, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America

a7 Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America

Abstract

Background Although survival to hospital discharge among children requiring extracorporeal membrane oxygenation support for medical and surgical cardio-circulatory failure has been reported in international registries, extended survival and re-hospitalisation rates have not been well described in the literature.

Material and methods This is a single-institution, retrospective review of all paediatric patients receiving extracorporeal membrane oxygenation for primary cardiac dysfunction over a 5-year period.

Results A total of 74 extracorporeal membrane oxygenation runs in 68 patients were identified, with a median follow-up of 5.4 years from hospital discharge. Overall, 66% of patients were decannulated alive and 25 patients (37%) survived to discharge. There were three late deaths at 5 months, 20 months, and 6.8 years from discharge. Of the hospital survivors, 88% required re-hospitalisation, with 63% of re-admissions for cardiac indications. The median number of hospitalisations per patient per year was 0.62, with the first re-admission occurring at a mean time of 9 months after discharge from the index hospitalisation. In all, 38% of patients required further cardiac surgery.

Conclusions Extended survival rates for paediatric hospital survivors of cardiac extracorporeal membrane oxygenation support for medical and post-surgical indications are encouraging. However, re-hospitalisation within the first year following hospital discharge is common, and many patients require further cardiac surgery. Although re-admission hospital mortality is low, longer-term follow-up of quality-of-life indicators is required.

(Received November 11 2011)

(Accepted April 29 2012)

(Online publication June 14 2012)

Keywords

  • Paediatric cardiac surgery;
  • mechanical assistance;
  • outcomes;
  • re-admissions

Correspondence

c1 Correspondence to: Dr E. M. da Cruz, MD, Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, School of Medicine, University of Colorado at Denver, 13120 East 16th Avenue, B-100, Aurora, Colorado 80045, United States of America. Tel: +1 720 777 4055; Fax: +1 720 777 7290; E-mail: eduardo.dacruz@childrenscolorado.org