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Central Surgical Association

49th Annual Meeting

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Extracorporeal Membrane Oxygenation: a 30-year review from a Quaternary Pediatric Institution
*Sergio A. Carrillo, Brian Schneider, Stacey Culp, Vicky Duffy, Matthew Deitemyer, Ashley Walczak, Janet Simsic
Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States

Background
Extracorporeal membrane oxygenation (ECMO) support has gained popularity over the years as an effective mechanism of support for the ailing heart and/or lungs of neonates, infants, children, and adults. Its use is now commonplace in many hospitals around the world.

Methods
In this retrospective, single-center, 30-year study (1989-2019), we sought to review ECMO patient characteristics, duration, indications including ECPR (extracorporeal cardiopulmonary resuscitation), support type and mode, major complications, and all-cause mortality in our Institution.

Results
A total of 616 patients were placed on ECMO with a median age and weight of 8 days (IQR 1-210) and 3.69 kg (IQR 3.06-6.8). The median length of support was 136 hours (IQR 87-229) while the lowest pH prior to ECMO initiation was 7.25 (SD 0.22). Type of support included cardiac (35.5%) and respiratory (64.5%), with veno-arterial (VA) the most common mode (83.3%) and ECPR accounting for 8.1% of cases. A total of 174 patients died while on ECMO (28.2%) and 214 patients died within 30 days after ECMO decannulation (34.7%). Mortality rate on ECMO was 18.4%, 28.7%, and 38.3% in the 1990s, 2000s, and 2010s, respectively (p < 0.001). Similarly, mortality within 30 days after ECMO decannulation was 20.6%, 42.0% and, 44.7% per decade, respectively (p < 0.001). There was an increase in ECPR cases from 0% to 7.6% to 16.2% per decade, respectively (p < 0.001). With diminishing survival, we observed an increase in severity of illness in our patient population being considered for ECMO support. Table 1 demonstrates a shift in patient risk profile during the study period, with an increase in age and weight (p < 0.001), along with a decrease in lowest pH prior to ECMO initiation (p < 0.001). The percentage of patients experiencing two or more major complications also increased (p < 0.001). Across all decades, the number of major complications predicted both death while on ECMO and death within 30 days after ECMO decannulation, with an OR 5.44 and 6.86, respectively, for a single complication (p<0.001) and OR 21.76 and 20.48, respectively, for two or more complications (p<0.001).

Conclusions
Similar to published international pediatric trends, our institutional ECMO utilization broadened over three decades, shifting from neonatal only, to older pediatric and adult patients alike. With the introduction of ECPR, coupled with the change in patient risk profile, there was a consequent rise in complications and mortality.


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