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Pediatr Crit Care Med. 2019 Aug;20(8):728-736. doi: 10.1097/PCC.0000000000001936.

Relationship Between Time to Left Atrial Decompression and Outcomes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support: A Multicenter Pediatric Interventional Cardiology Early-Career Society Study.

Author information

1
Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI.
2
Department of Cardiology, Boston Children's Hospital, Boston, MA.
3
Division of Pediatric Cardiology, University of Nebraska Children's Hospital, Omaha, NE.
4
Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT.
5
Division of Pediatric Cardiology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL.
6
Department of Cardiology, Kosair Children's Hospital, Louisville, KY.
7
Division of Pediatric Cardiology, University of Illinois College of Medicine at Peoria, Peoria, IL.
8
Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO.
9
Division of Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
10
Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY.
11
Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX.
12
The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.

Abstract

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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