title: Extracorporeal membrane oxygenation support after the Fontan operation.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation has been used to support children with cardiac failure after the Fontan operation. Mortality is high, and causes of mortality remain unclear. We evaluated the in-hospital mortality and factors associated with mortality in these patients.
  
  
  METHODS
  Extracorporeal Life Support Organization registry data on patients requiring extracorporeal membrane oxygenation after the Fontan operation from 1987 to 2009 were retrospectively analyzed. Demographics and extracorporeal membrane oxygenation data were compared for survivors and nonsurvivors. A multivariable logistic regression model was used to identify factors associated with mortality.
  
  
  RESULTS
  Of 230 patients, 81 (35%) survived to hospital discharge. Cardiopulmonary resuscitation was more frequent (34% vs 17%, P = .04), and median fraction of inspired oxygen concentration was higher (1 [confidence interval, 0.9-1.0] vs 0.9 [confidence interval, 0.8-1.0], P = .03) before extracorporeal membrane oxygenation in nonsurvivors compared with survivors. Extracorporeal membrane oxygenation duration and incidence of complications, including surgical bleeding, neurologic injury, renal failure, inotrope use on extracorporeal membrane oxygenation, and bloodstream infection, were higher in nonsurvivors compared with survivors (P < .05 for all). In a multivariable model, neurologic injury (odds ratio, 5.18; 95% confidence interval, 1.97-13.61), surgical bleeding (odds ratio, 2.36; 95% confidence interval, 1.22-4.56), and renal failure (odds ratio, 2.81; 95% confidence interval, 1.41-5.59) increased mortality. Extracorporeal membrane oxygenation duration of more than 65 hours to 119 hours (odds ratio, 0.33; 95% confidence interval, 0.14-0.76) was associated with decreased mortality.
  
  
  CONCLUSIONS
  Cardiac failure requiring extracorporeal membrane oxygenation after the Fontan operation is associated with high mortality. Complications during extracorporeal membrane oxygenation support increase mortality odds. Prompt correction of surgical bleeding when possible may improve survival.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Mass 02115, USA. kelly.rood@cardio.chboston.org
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Rood
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Teele
authors.forename: Cindy S
authors.initials: CS
authors.lastname: Barrett
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Salvin
authors.forename: Peter T
authors.initials: PT
authors.lastname: Rycus
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
mesh_terms: D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D018729:Fontan Procedure; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D016019:Survival Analysis