• Jeffrey D Zampi, Fares Alghanem, Sunkyung Yu, Ryan Callahan, Christopher L Curzon, Jeffrey W Delaney, Robert G Gray, Carrie E Herbert, Ryan A Leahy, Ray Lowery, Sara K Pasquali, Priti M Patel, Diego Porras, Shabana Shahanavaz, Ravi R Thiagarajan, Sara M Trucco, Mariel E Turner, Surendranath R Veeram Reddy, Shawn C West, Wendy Whiteside, and Bryan H Goldstein.
• Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI.
• Pediatr Crit Care Me. 2019 Aug 1; 20 (8): 728-736.

ObjectivesTo 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.DesignMulticenter retrospective study.SettingEleven pediatric hospitals within the United States.PatientsPatients less than 18 years on venoarterial extracorporeal membrane oxygenation who underwent left atrial decompression from 2004 to 2016.InterventionsNone.Measurements And Main ResultsA 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.ConclusionsIn 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.

23 keywords...

hide…