title: Outcomes after prolonged extracorporeal membrane oxygenation support in children with cardiac disease--Extracorporeal Life Support Organization registry study.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation remains the mainstay of mechanical circulatory support initiation and maintenance in children with cardiac insufficiency. However, the outcomes after prolonged extracorporeal membrane oxygenation for cardiac insufficiency in children remain ill defined.
  
  
  METHODS
  We reviewed the International Extracorporeal Life Support Organization data from January 1, 2000, through December 31, 2011. We defined prolonged extracorporeal membrane oxygenation as uninterrupted support for ≥14 days.
  
  
  RESULTS
  A total of 777 children aged <18 years required extracorporeal membrane oxygenation support for ≥14 days. Of these, 176 (23%) survived to hospital discharge. Compared with the nonsurvivors, the survivors were older (median age, 0.64 vs 0.10 years; P < .01), weighed more (median weight, 7.0 kg; range, 2-90; vs median, 4.0; range, 1.4-100 kg; P < .01), had a shorter duration of support (mean, 20 ± 6 vs 22 ± 9 days; P < .01), and a fewer number of organ system complications (mean, 2.8 ± 1.7 vs 3.6 ± 1.6, P < .01). Children with congenital heart disease had worse survival than those with cardiomyopathy and myocarditis (15% vs 42% and 52%, respectively; P < .01), and those with 1-ventricle physiology had worse survival than those with 2-ventricle physiology (10% vs 18%, P = .01). Seven percent (n = 56) reached cardiac transplantation, with 66% surviving to hospital discharge versus 19% of those not transplanted (P < .01).
  
  
  CONCLUSIONS
  The attrition is high after prolonged extracorporeal membrane oxygenation support for cardiac insufficiency in children. Cardiac transplantation in this cohort was rarely achieved and was associated with high mortality compared with benchmarks for cardiac transplantation survival. Earlier redirection of care or conversion to other modes of mechanical support as a bridge to transplantation should be considered.
authors.affiliation: University of Missouri Kansas City School of Medicine, Kansas City, Mo.
authors.forename: Eric Dean
authors.initials: ED
authors.lastname: Merrill
authors.affiliation: University of Missouri Kansas City School of Medicine, Kansas City, Mo.
authors.forename: Laura
authors.initials: L
authors.lastname: Schoeneberg
authors.affiliation: University of Missouri Kansas City School of Medicine, Kansas City, Mo.
authors.forename: Pratik
authors.initials: P
authors.lastname: Sandesara
authors.affiliation: University of Missouri Kansas City School of Medicine, Kansas City, Mo; Heart Center, Children's Mercy Hospital, Kansas City, Mo.
authors.forename: Erica
authors.initials: E
authors.lastname: Molitor-Kirsch
authors.affiliation: University of Missouri Kansas City School of Medicine, Kansas City, Mo; Heart Center, Children's Mercy Hospital, Kansas City, Mo.
authors.forename: James
authors.initials: J
authors.lastname: O'Brien
authors.affiliation: University of Missouri Kansas City School of Medicine, Kansas City, Mo; Heart Center, Children's Mercy Hospital, Kansas City, Mo.
authors.forename: Hongying
authors.initials: H
authors.lastname: Dai
authors.affiliation: University of Missouri Kansas City School of Medicine, Kansas City, Mo; Heart Center, Children's Mercy Hospital, Kansas City, Mo. Electronic address: graghuveer@cmh.edu.
authors.forename: Geetha
authors.initials: G
authors.lastname: Raghuveer
mesh_terms: D000293:Adolescent; D000367:Age Factors; D009202:Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009205:Myocarditis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D010351:Patient Discharge; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome