Midterm survival of infants requiring postoperative extracorporeal membrane oxygenation after Norwood palliation

Mark G. Debrunner, Prashob Porayette, John P. Breinholt, Mark Turrentine, Timothy M. Cordes

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

This study reports the mid-term survival for neonates undergoing extracorporeal membrane oxygenation (ECMO) after Norwood palliation at a single center. Limited data exist on the mid-term survival of patients undergoing ECMO after Norwood palliation. We reviewed our ECMO experience from July 1994 to October 2008 and compared two groups: patients who required ECMO after Norwood palliation and patients who underwent Norwood palliation without ECMO. We analyzed 30-day survival, survival to hospital discharge, and survival to most recent follow-up. One hundred sixty patients underwent Norwood palliation for hypoplastic left heart syndrome (HLHS) and its variants. A total of 32 patients (20 %) required postoperative ECMO. Using Kaplan-Meier analysis, the predicted survival rates for Norwood/non-ECMO patients to 30 days, 1 year, and 3 years after the procedure are 87.6 % (CI 79.5-91.5 %), 62.5 % (CI 54.3-71.0 %), and 59.9 % (CI 50.8-67.8 %), respectively. Survival to 30 days, 1 year, and 3 years after Norwood was significantly decreased in Norwood/ ECMO patients, with predicted survival rates of 50.0 % (CI 31.9-65.7 %), 24.6 % (CI 11.4-40.4), and 13.2 % (CI 3.9-28.3 %), respectively (p < 0.0001). Risk factors for hospital mortality included nonelective or emergency placement onto ECMO, longer duration of ECMO support, and the development of acute renal failure while on ECMO. Of the original Norwood/ECMO hospital survivors, only half of these patients survived a mean of nearly 4 years. ECMO after Norwood palliation is associated with significant mortality. Our data suggest that neonates who require ECMO after Norwood palliation are prone to continued attrition once discharged from the hospital.

Original languageEnglish
Pages (from-to)570-575
Number of pages6
JournalPediatric Cardiology
Volume34
Issue number3
DOIs
StatePublished - Mar 2013

Fingerprint

Extracorporeal Membrane Oxygenation
Survival
Survival Rate
Newborn Infant
Hypoplastic Left Heart Syndrome
Kaplan-Meier Estimate
Hospital Mortality
Acute Kidney Injury
Survivors
Emergencies

Keywords

  • ECMO
  • Hypoplastic left heart syndrome (HLHS)
  • Norwood palliation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Midterm survival of infants requiring postoperative extracorporeal membrane oxygenation after Norwood palliation. / Debrunner, Mark G.; Porayette, Prashob; Breinholt, John P.; Turrentine, Mark; Cordes, Timothy M.

In: Pediatric Cardiology, Vol. 34, No. 3, 03.2013, p. 570-575.

Research output: Contribution to journalArticle

Debrunner, Mark G. ; Porayette, Prashob ; Breinholt, John P. ; Turrentine, Mark ; Cordes, Timothy M. / Midterm survival of infants requiring postoperative extracorporeal membrane oxygenation after Norwood palliation. In: Pediatric Cardiology. 2013 ; Vol. 34, No. 3. pp. 570-575.
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abstract = "This study reports the mid-term survival for neonates undergoing extracorporeal membrane oxygenation (ECMO) after Norwood palliation at a single center. Limited data exist on the mid-term survival of patients undergoing ECMO after Norwood palliation. We reviewed our ECMO experience from July 1994 to October 2008 and compared two groups: patients who required ECMO after Norwood palliation and patients who underwent Norwood palliation without ECMO. We analyzed 30-day survival, survival to hospital discharge, and survival to most recent follow-up. One hundred sixty patients underwent Norwood palliation for hypoplastic left heart syndrome (HLHS) and its variants. A total of 32 patients (20 {\%}) required postoperative ECMO. Using Kaplan-Meier analysis, the predicted survival rates for Norwood/non-ECMO patients to 30 days, 1 year, and 3 years after the procedure are 87.6 {\%} (CI 79.5-91.5 {\%}), 62.5 {\%} (CI 54.3-71.0 {\%}), and 59.9 {\%} (CI 50.8-67.8 {\%}), respectively. Survival to 30 days, 1 year, and 3 years after Norwood was significantly decreased in Norwood/ ECMO patients, with predicted survival rates of 50.0 {\%} (CI 31.9-65.7 {\%}), 24.6 {\%} (CI 11.4-40.4), and 13.2 {\%} (CI 3.9-28.3 {\%}), respectively (p < 0.0001). Risk factors for hospital mortality included nonelective or emergency placement onto ECMO, longer duration of ECMO support, and the development of acute renal failure while on ECMO. Of the original Norwood/ECMO hospital survivors, only half of these patients survived a mean of nearly 4 years. ECMO after Norwood palliation is associated with significant mortality. Our data suggest that neonates who require ECMO after Norwood palliation are prone to continued attrition once discharged from the hospital.",
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