title: Extracorporeal membrane oxygenation after stage 1 palliation for hypoplastic left heart syndrome.
abstract: OBJECTIVE
  To report the outcomes from a large multicenter cohort of neonates requiring extracorporeal membrane oxygenation (ECMO) after stage 1 palliation for hypoplastic left heart syndrome.
  
  
  METHODS
  Using data from the Extracorporeal Life Support Organization (2000-2009), we computed the survival to hospital discharge for neonates (age ≤30 days) supported with ECMO after stage 1 palliation for hypoplastic left heart syndrome. The factors associated with mortality were evaluated using multivariate logistic regression analysis.
  
  
  RESULTS
  Among 738 neonates, the survival rate was 31%. The median age at cannulation was 7 days (interquartile range, 4-11). Black race (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2-3.6), mechanical ventilation before ECMO (>15-131 hours: OR, 1.6; 95% CI, 1.1-2.4; >131 hours: OR, 1.9; 95% CI, 1.3-2.9), use of positive end expiratory pressure (>6-8 cm H(2)O: OR, 1.7; 95% CI, 1.1-2.7; >8 cm H(2)O: OR, 1.9; 95% CI, 1.2-3.1), and longer ECMO duration (per day, OR, 1.2; 95% CI, 1.1-1.3) increased mortality. ECMO support for failure to wean from cardiopulmonary bypass (OR, 1.6; 95% CI, 1.02-2.4) also decreased survival. ECMO complications, including renal failure (OR, 1.9; 95% CI, 1.2-3.1), inotrope requirement (OR, 1.5; 95% CI, 1.1-2.1), myocardial stun (OR, 3.2; 95% CI, 1.3-7.7), metabolic acidosis (OR, 2.9; 95% CI, 1.3-6.7), and neurologic injury (OR, 1.7; 95% CI, 1.1-2.6), during support also increased mortality.
  
  
  CONCLUSIONS
  Mortality for neonates with hypoplastic left heart syndrome supported with ECMO after stage 1 palliation is high. Longer ventilation before cannulation, longer support duration, and ECMO complications increased mortality.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Boston, Mass 02115, USA. elizabeth.sherwin@cardio.chboston.org
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Sherwin
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Mark A
authors.initials: MA
authors.lastname: Scheurer
authors.forename: Peter T
authors.initials: PT
authors.lastname: Rycus
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Salvin
authors.forename: Melvin C
authors.initials: MC
authors.lastname: Almodovar
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
mesh_terms: D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D058327:Norwood Procedures / Q000009:adverse effects* / Q000401:mortality; D016017:Odds Ratio; D010166:Palliative Care; D010351:Patient Discharge; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012042:Registries; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States