Advanced search×

Extracorporeal membrane oxygenation support after the Fontan operation

Kelly L Rood, Sarah A Teele, Cindy S Barrett, Joshua W Salvin, Peter T Rycus, Francis Fynn-Thompson, Peter C Laussen, and Ravi R Thiagarajan

J Thorac Cardiovasc Surg 142(3):7 (2011) PMID 21353253

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.

Copyright © 2011 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jtcvs.2010.11.050
Version: za2963e q8zad q8zb6 q8zc8 q8zda q8ze6 q8zf2 q8zg7

Similar articles you may find interesting…

  1. Restoration of facial form and function after severe disfigurement from burn injury by a composite facial allograft.
    B B Pomahac, J J Pribaz, ... S G SG Tullius

    Audio, Transactions of the IRE Profession... 11(2):386-93 (2011) PMID 21214855

    We report an excellent functional and anatomical restoration 1 year after face transplantation. A 59-year-old male with severe disfigurement from electrical burn injury was treated with a facial allograft composed of bone and soft tissues to restore midfacial form and function. An initial potent ant...
  2. Mandibular Condyle Fractures
    Roberto Cenzi, Dante Burlini, ... Francesco Carinci

    J Craniofac Surg 20(1):24-28 (2009) PMID 19164983

    We performed a retrospective study on a series of patients affected by CFs.The Strasbourg Osteosynthesis Research Group classification defines 3 main types of CFs: diacapitular fracture (i.e., through the head of the condyle [DF]), fracture of the condylar neck, and fracture of the condylar base (CB...
  3. Race/ethnicity and acute respiratory distress syndrome: a National Trauma Data Bank study.
    Gabriel E Ryb and Carnell Cooper

    J Natl Med Assoc 102(10):865-9 (2010) PMID 21053700

    We studied whether black blunt-trauma patients experience different ARDS incidence, ARDS-associated mortality, or ARDS case fatality rates. National Trauma Data Bank (NTDB) extracts of blunt-trauma patients with Injury Severity Score (ISS) greater than 16 and length of stay greater than 3 days were...