PEDS2: Impact of Mechanical Ventilation Duration on Outcomes in Children after Ventricular Assist Device Placement: A linked analysis from the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) and Pediatric Cardiac Critical Care Consortium (PC4) Registries.

Abstract

Background: Placement of a ventricular assist device (VAD) has improved outcomes in children with advanced heart failure (HF), but adverse events, such as stroke and mortality, remain important consequences. It is unknown what impact prolonged post-operative mechanical ventilation (MV) has on these outcomes. Methods: ACTION and PC4 are audited, comprehensive, encounter-based registries of patient course and outcomes for pediatric HF and pediatric cardiac critical care, respectively. Data from initial VAD placement in each registry from 8/2014-7/2020 were linked using indirect patient identifiers with 98% match concordance. Patient demographics, heart disease, pre- and post-op ICU courses and outcomes were compiled. Descriptive and univariate statistics assessed association of patient factors with prolonged post-op MV. Multivariable logistic regression sought independent associations with outcomes. Results: Overall, 248 ACTION subjects were linked to a matching patient in PC4. Median age was 7.7 years (1.5-15.5), weight 21.3kg (9.1-58), 56% male. Primary diagnosis was congenital heart disease (CHD) in 35%. Pre-VAD variables that independently predicted prolonged post-op MV included age (IRR=0.95 [95%CI: 0.93-0.96], p<0.01); renal dysfunction: eGFR 30-60 (IRR=3.28 [95%CI: 1.11-9.68], p=0.032), eGFR 60-90 (IRR=3.87 [95%CI: 1.35-11.07], p=0.012); pre-op MV within 48 hours (IRR=2.76 [95%CI: 1.59-4.79], p<0.01), 2-7 days (IRR=1.82 [95%CI: 1.15-2.89], p=0.011), and >7days before implant (IRR=2.35 [95%CI: 1.62-3.4], p<0.01); and CHD (IRR=1.96 [95%CI: 1.48-2.59], p<0.01). Each additional day of post-op MV was associated with increased risk of death (OR 1.09 per day, p<0.01) in the full cohort. Association of post-operative MV duration with mortality is presented in Figure 1. By device type, duration of post-op MV had no association with outcomes in extracorporeal devices (n=77), but remained strongly associated with risk of death in intracorporeal devices (n=102) (OR=1.24 [95%CI: 1.04-1.48], p=0.014). Conclusion: There is increased risk of death per day of MV after VAD placement, however, this did not hold true with extracorporeal devices. Further studies are warranted.