Key result
Late left atrial decompression on VA-ECMO is linked to ~4.4-fold higher odds of prolonged ECMO.
Why the study?
Variation in the timing of left atrial decompression and its association with clinical outcomes in pediatric patients supported with venoarterial ECMO was not well understood.
Does early left atrial decompression reduce extracorporeal membrane oxygenation duration in pediatric patients on venoarterial extracorporeal membrane oxygenation?
Cohort (n=137)
Yes
Does early left atrial decompression reduce extracorporeal membrane oxygenation duration in pediatric patients on venoarterial extracorporeal membrane oxygenation?
Late left atrial decompression (≥ 18 hours) in pediatric patients on VA-ECMO is associated with prolonged ECMO and mechanical ventilation duration, though not with survival differences.
Answers are grounded in this paper and cite their sources.
May support earlier decompression to shorten support times; hypothesis-generating for timing in pediatric VA-ECMO.
Objectives: To assess the variation in timing of left atrial decompression and its association with clinical outcomes in pediatric patients supported with venoarterial extracorporeal membrane oxygenation across a multicenter cohort. Design: Multicenter retrospective study. Setting: Eleven pediatric hospitals within the United States. Patients: Patients less than 18 years on venoarterial extracorporeal membrane oxygenation who underwent left atrial decompression from 2004 to 2016. Interventions: None. Measurements and Main Results: A total of 137 patients (median age, 4.7 yr) were included. Cardiomyopathy was the most common diagnosis (47%). Cardiac arrest (39%) and low cardiac output (50%) were the most common extracorporeal membrane oxygenation indications. Median time to left atrial decompression was 6.2 hours (interquartile range, 3.8–17.2 hr) with the optimal cut-point of greater than or equal to 18 hours for late decompression determined by receiver operating characteristic curve. In univariate analysis, late decompression was associated with longer extracorporeal membrane oxygenation duration (median 8.5 vs 5 d; p = 0.02). In multivariable analysis taking into account clinical confounder and center effects, late decompression remained significantly associated with prolonged extracorporeal membrane oxygenation duration (adjusted odds ratio, 4.4; p = 0.002). Late decompression was also associated with longer duration of mechanical ventilation (adjusted odds ratio, 4.8; p = 0.002). Timing of decompression was not associated with in-hospital survival ( p = 0.36) or overall survival ( p = 0.42) with median follow-up of 3.2 years. Conclusions: In this multicenter study of pediatric patients receiving venoarterial extracorporeal membrane oxygenation, late left atrial decompression (≥ 18 hr) was associated with longer duration of extracorporeal membrane oxygenation support and mechanical ventilation. Although no survival benefit was demonstrated, the known morbidities associated with prolonged extracorporeal membrane oxygenation use may justify a recommendation for early left atrial decompression.
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Zampi et al. (2019) conducted a cohort in Pediatric patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) requiring left atrial decompression (n=137). Late left atrial decompression (≥18 hours) vs. Early left atrial decompression (<18 hours) was evaluated on Prolonged extracorporeal membrane oxygenation duration (OR 4.4, p=0.002). Late left atrial decompression (≥18 hr) on VA-ECMO was associated with prolonged ECMO duration (aOR 4.4; p=0.002) and mechanical ventilation (aOR 4.8; p=0.002), without affecting survival.
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