Citation Information :
Aiello S, Loomba R, Kriz C, Buelow M, Aggarwal S, Arora R. The need for extracorporeal membrane oxygenation in adults undergoing congenital heart surgery: Impact and trends of utilization. Indian J Crit Care Med 2017; 21 (9):547-551.
Introduction: Adults with congenital heart disease (ACHD) represent a population with unique health-care needs. Many patients require cardiac surgery, with some requiring postoperative extracorporeal membrane oxygenation (ECMO). This study aimed to identify the risk factors for the need of postoperative ECMO and characterize the impact of ECMO on admission characteristics.
Methods: Data from the 2005–2012 iterations of the Nationwide Inpatient Sample were used. ACHD admissions over 18 years with a documented cardiac surgery were included. Univariate analysis was conducted to compare the characteristics between those requiring ECMO and those who did not. Regression analysis was done to identify the independent risk factors associated with ECMO and to determine the impact of ECMO on length, cost, and mortality of the admission.
Results: A total of 186,829 admissions were included. Of these, 446 (0.2%) admissions required ECMO. Those with acute kidney injury, double-outlet right ventricle, or total anomalous pulmonary venous connection were more likely to require ECMO. ECMO was also significantly more utilized in patients undergoing septal defect repair, complete repair of tetralogy of Fallot, atrial switch, and heart transplant. The use of ECMO significantly increased length, cost, and mortality of stay. Overall mortality was 62.6% in the ECMO group.
Conclusion: ECMO is only needed in a small proportion of postoperative ACHD patients. The use of ECMO significantly increases cost, length of stay and mortality in these patients. Improved identification of postoperative ACHD patients who are more likely to survive ECMO may facilitate improved survival and decreased resource utilization.
van der Bom T, Mulder BJ, Meijboom FJ, van Dijk AP, Pieper PG, Vliegen HW, et al. Contemporary survival of adults with congenital heart disease. Heart 2015;101:1989-95.
Marelli AJ, Ionescu-Ittu R, Mackie AS, Guo L, Dendukuri N, Kaouache M, et al. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation 2014;130:749-56.
Benziger CP, Stout K, Zaragoza-Macias E, Bertozzi-Villa A, Flaxman AD. Projected growth of the adult congenital heart disease population in the United States to 2050: An integrative systems modeling approach. Popul Health Metr 2015;13:29.
Agarwal S, Sud K, Menon V. Nationwide hospitalization trends in adult congenital heart disease across 2003-2012. J Am Heart Assoc 2016;5:43-54.
Bhatt AB, Rajabali A, He W, Benavidez OJ. High resource use among adult congenital heart surgery admissions in adult hospitals: Risk factors and association with death and comorbidities. Congenit Heart Dis 2015;10:13-20.
Rodriguez FH 3rd, Moodie DS, Parekh DR, Franklin WJ, Morales DL, Zafar F, et al. Outcomes of heart failure-related hospitalization in adults with congenital heart disease in the United States. Congenit Heart Dis 2013;8:513-9.
Acheampong B, Johnson JN, Stulak JM, Dearani JA, Kushwaha SS, Daly RC, et al. Postcardiotomy ECMO support after high-risk operations in adult congenital heart disease. Congenit Heart Dis 2016;11:751-5.
Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, et al. Predicting survival after ECMO for refractory cardiogenic shock: The survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J 2015;36:2246-56.
Uilkema RJ, Otterspoor LC. Extracorporeal membrane oxygenation in adult patients with congenital heart disease. Neth Heart J 2014;22:520-2.
Paden ML, Conrad SA, Rycus PT, Thiagarajan RR, ELSO Registry. Extracorporeal life support organization registry report 2012. ASAIO J 2013;59:202-10.
Fernandes SM, Chamberlain LJ, Grady S Jr. Saynina O, Opotowsky AR, Sanders L, et al. Trends in utilization of specialty care centers in california for adults with congenital heart disease. Am J Cardiol 2015;115:1298-304.
Anselmi A, Flécher E, Corbineau H, Langanay T, Le Bouquin V, Bedossa M, et al. Survival and quality of life after extracorporeal life support for refractory cardiac arrest: A case series. J Thorac Cardiovasc Surg 2015;150:947-54.
Chen KH, Tsai FC, Tsai CS, Yeh SL, Weng LC, Yeh LC, et al. Problems and health needs of adult extracorporeal membrane oxygenation patients following hospital discharge: A qualitative study. Heart Lung 2016;45:147-53.
Mojoli F, Venti A, Pellegrini C, De Ferrari GM, Ferlini M, Zanierato M, et al. Hospital survival and long term quality of life after emergency institution of venoarterial ECMO for refractory circulatory collapse. Minerva Anestesiol 2013;79:1147-55.
Hsieh FT, Huang GS, Ko WJ, Lou MF. Health status and quality of life of survivors of extra corporeal membrane oxygenation: A cross-sectional study. J Adv Nurs 2016;72:1626-37.