Key result
Among pediatric patients requiring venoarterial ECMO for severe heart failure, 44% survived to 30 days and 28% were alive at 7-year follow-up.
Why the study?
An increasing number of neonatal and pediatric patients with severe heart failure benefit from ECMO support, warranting evaluation of outcomes and predictors of 30-day mortality and mid- to long-term survival.
Cohort (n=39)
No
Venoarterial ECMO provides a viable life-saving therapy for pediatric patients with severe heart failure, achieving a 44% 30-day survival and 28% long-term survival up to 7 years.
Identifies predictors of 30-day mortality after pediatric vaECMO; hypothesis-generating for risk stratification before prospective validation.
Nowadays, an increasing number of neonatal and pediatric patients with severe heart failure benefits from extracorporeal membrane oxygenation (ECMO) support. A total of 39 pediatric patients needed venoarterial ECMO (vaECMO) support in our department between January 2008 and December 2016. Patients were retrospectively divided in two groups: 30-day survivor group (17 patients) and 30-day nonsurvivor group (22 patients). Outcome and factors predictive for 30-day mortality and mid- as well as long-term survival up to 7-year follow-up were analyzed by univariate analysis and Kaplan-Meier survival estimation. Basic demographics and preoperative characteristics did not differ between groups (P > 0.05). 67% of patients were successfully weaned off ECMO and 44% survived 30-day after ECMO application. After 7-year follow-up 28% of pediatric patients were alive. Thirty-day survivors were significantly more likely to undergo elective cardiac surgery (P = 0.001), whereas significantly more 30-day nonsurvivors underwent urgent surgery (P = 0.004). Odds of incidence of catecholamine refractory circulatory failure, failed myocardial recovery, and cerebral edema was significantly higher in 30-day nonsurvivor group (41.6-fold, 16-fold, and 2.5-fold, respectively). Kaplan-Meier survival estimation analysis revealed significant differences in terms of mid- and long-term survival among neonates, infants, toddlers, and preadolescents (Breslow P = 0.037 and Log-Rank P = 0.028, respectively). vaECMO provides an efficient therapy option for life-threatening heart disorders in neonates and pediatric patients being at high risk for myocardial failure leading to circulatory arrest. Urgency of surgery effected on higher mortality, but there was no difference in terms of mortality in 30-day survivor group in comparison to 30-day nonsurvivor group among neonates, infants, toddlers, and preadolescents.
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Merkle et al. (2019) conducted a cohort in severe heart failure (n=39). venoarterial ECMO (vaECMO) was evaluated on 30-day survival. Among pediatric patients requiring venoarterial ECMO for severe heart failure, 44% survived to 30 days and 28% were alive at 7-year follow-up.
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