Use of venovenous extracorporeal life support in pediatric patients for cardiac indications

Abstract

To describe survival outcomes for pediatric patients supported on venovenous extracorporeal life support with cardiac indications and identify predictors of successful application of venovenous extracorporeal life support. Retrospective review of Extracorporeal Life Support Organization registry database. Data reported from extracorporeal membrane oxygenation centers to the Extracorporeal Life Support Organization. Patients ≤18 yrs of age with cardiac diagnoses initiated on venovenous extracorporeal life support during 1985 to 2007. None. Of 8,551 reported pediatric extracorporeal life support cases for cardiac indications during 1985 to 2007, 133 patients received venovenous extracorporeal life support (1.6%); 56 (42%) survived to hospital discharge, comprising the venovenous success group. Of 77 (58%) in the venovenous failure group, 45 (34%) died on venovenous extracorporeal life support and 32 (24%) were converted to venoarterial extracorporeal life support. Median duration of extracorporeal life support course was shorter in the venovenous success group (76 vs. 133 hrs, odds ratio 1.01, 95% confidence interval 1.00-1.01). In the univariate analysis, patients in the venovenous failure group had lower median arterial pH (odds ratio 0.06, 95% confidence intervals 0.01-0.61) and higher PaO(2) (odds ratio 1.02, 95% confidence interval 1.00-1.04). Complications from extracorporeal life support, including receipt of renal replacement therapy (odds ratio 4.35, 95% confidence interval 1.87-10.11), surgical hemorrhage (odds ratio 2.56, 95% confidence interval 1.05-6.25), use of inotropic infusions (odds ratio 2.53, 95% confidence interval 1.24-5.15), and infections (odds ratio 4.99, 95% confidence interval 1.07-23.25), were associated with increased odds for venovenous failure. In a multivariable model, the highest PaO(2) (PaO(2) ≥52 torr) compared to the lowest (PaO(2) ≤ 22 torr) (odds ratio 3.75, 95% confidence interval 1.11-12.57), and use of renal replacement therapy (odds ratio 4.35, 95% confidence interval 1.8710.11) were associated with increased odds of venovenous failure. Venovenous extracorporeal life support appears to be an appropriate choice in some children with cardiac failure but better definition of this population is needed.