Extracorporeal membrane oxygenation support for intractable primary arrhythmias and complete congenital heart block in newborns and infants: Short-term and medium-term outcomes

Umesh Dyamenahalli, Volkan Tuzcu, Eudice Fontenot, John Papagiannis, Rdb Jaquiss, Adnan Bhutta, William R. Morrow, Christopher C. Erickson, Michiaki Imamura, Parthak Prodhan

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVES:: To describe the experience with extracorporeal membrane oxygenation support for intractable primary arrhythmias in newborns and infants. DESIGN:: Retrospective study. SETTING:: A tertiary care pediatric hospital. PATIENTS:: Patients younger than 1 yr supported with extracorporeal membrane oxygenation for primary cardiac arrhythmias were identified from the institutional extracorporeal membrane oxygenation registry. INTERVENTIONS:: Extracorporeal membrane oxygenation support. MEASUREMENTS AND MAIN RESULTS:: Clinical characteristics and outcomes were investigated for patients with primary cardiac arrhythmia supported with extracorporeal membrane oxygenation. Outcomes investigated were time from initiation of extracorporeal membrane oxygenation support to arrhythmia control, duration of extracorporeal membrane oxygenation support, and results of interventions performed while supported with extracorporeal membrane oxygenation. We summarized the independent categorical and continuous variables using frequencies, percentages, and medians and ranges, respectively. Extracorporeal membrane oxygenation support was used in nine patients for rescue therapy for primary tachyarrhythmia and bradycardia. The primary arrhythmias were: focal atrial tachycardia (n = 2); reentrant supraventricular tachycardia (n = 3); junctional ectopic tachycardia (n = 2); and congenital complete atrioventricular block (n = 2) patients. Seven patients presented with severe hemodynamic compromise, with six patients requiring extracorporeal cardiopulmonary resuscitation. All patients required extracorporeal membrane oxygenation within 24 hrs of initial presentation. Balloon atrial septostomy was performed in three patients and ablation was performed in two patients. Sinus rhythm was achieved in all reentrant supraventricular tachycardia and rate control was established in both patients with focal atrial tachycardia and in one patient with junctional ectopic tachycardia while using extracorporeal membrane oxygenation support. All patients survived to hospital discharge, and median follow-up for the cohort was 5 yrs. There was one late death; all survivors had good overall and neurologic outcomes. CONCLUSIONS:: The requirement of extracorporeal membrane oxygenation support in newborns and infants with intractable arrhythmia is rare. Extracorporeal membrane oxygenation support does potentially carry morbidity; however, to prevent arrhythmia-related mortality, extracorporeal membrane oxygenation support and/or extracorporeal cardiopulmonary resuscitation should be considered in the management of hemodynamically unstable primary arrhythmias as an emergent lifesaving procedure.

Original languageEnglish (US)
Pages (from-to)47-52
Number of pages6
JournalPediatric Critical Care Medicine
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2012

Fingerprint

Extracorporeal Membrane Oxygenation
Cardiac Arrhythmias
Newborn Infant
Ectopic Junctional Tachycardia
Tachycardia
Supraventricular Tachycardia
Cardiopulmonary Resuscitation
Congenital heart block
Pediatric Hospitals
Atrioventricular Block
Tertiary Healthcare
Bradycardia
Nervous System
Survivors
Registries

Keywords

  • ablation
  • congenital heart block
  • extracorporeal membrane oxygenation
  • infants
  • intractable arrhythmias
  • septos-tomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Extracorporeal membrane oxygenation support for intractable primary arrhythmias and complete congenital heart block in newborns and infants : Short-term and medium-term outcomes. / Dyamenahalli, Umesh; Tuzcu, Volkan; Fontenot, Eudice; Papagiannis, John; Jaquiss, Rdb; Bhutta, Adnan; Morrow, William R.; Erickson, Christopher C.; Imamura, Michiaki; Prodhan, Parthak.

In: Pediatric Critical Care Medicine, Vol. 13, No. 1, 01.01.2012, p. 47-52.

Research output: Contribution to journalArticle

Dyamenahalli, Umesh ; Tuzcu, Volkan ; Fontenot, Eudice ; Papagiannis, John ; Jaquiss, Rdb ; Bhutta, Adnan ; Morrow, William R. ; Erickson, Christopher C. ; Imamura, Michiaki ; Prodhan, Parthak. / Extracorporeal membrane oxygenation support for intractable primary arrhythmias and complete congenital heart block in newborns and infants : Short-term and medium-term outcomes. In: Pediatric Critical Care Medicine. 2012 ; Vol. 13, No. 1. pp. 47-52.
@article{645d252581284edea5ec7064780f868c,
title = "Extracorporeal membrane oxygenation support for intractable primary arrhythmias and complete congenital heart block in newborns and infants: Short-term and medium-term outcomes",
abstract = "OBJECTIVES:: To describe the experience with extracorporeal membrane oxygenation support for intractable primary arrhythmias in newborns and infants. DESIGN:: Retrospective study. SETTING:: A tertiary care pediatric hospital. PATIENTS:: Patients younger than 1 yr supported with extracorporeal membrane oxygenation for primary cardiac arrhythmias were identified from the institutional extracorporeal membrane oxygenation registry. INTERVENTIONS:: Extracorporeal membrane oxygenation support. MEASUREMENTS AND MAIN RESULTS:: Clinical characteristics and outcomes were investigated for patients with primary cardiac arrhythmia supported with extracorporeal membrane oxygenation. Outcomes investigated were time from initiation of extracorporeal membrane oxygenation support to arrhythmia control, duration of extracorporeal membrane oxygenation support, and results of interventions performed while supported with extracorporeal membrane oxygenation. We summarized the independent categorical and continuous variables using frequencies, percentages, and medians and ranges, respectively. Extracorporeal membrane oxygenation support was used in nine patients for rescue therapy for primary tachyarrhythmia and bradycardia. The primary arrhythmias were: focal atrial tachycardia (n = 2); reentrant supraventricular tachycardia (n = 3); junctional ectopic tachycardia (n = 2); and congenital complete atrioventricular block (n = 2) patients. Seven patients presented with severe hemodynamic compromise, with six patients requiring extracorporeal cardiopulmonary resuscitation. All patients required extracorporeal membrane oxygenation within 24 hrs of initial presentation. Balloon atrial septostomy was performed in three patients and ablation was performed in two patients. Sinus rhythm was achieved in all reentrant supraventricular tachycardia and rate control was established in both patients with focal atrial tachycardia and in one patient with junctional ectopic tachycardia while using extracorporeal membrane oxygenation support. All patients survived to hospital discharge, and median follow-up for the cohort was 5 yrs. There was one late death; all survivors had good overall and neurologic outcomes. CONCLUSIONS:: The requirement of extracorporeal membrane oxygenation support in newborns and infants with intractable arrhythmia is rare. Extracorporeal membrane oxygenation support does potentially carry morbidity; however, to prevent arrhythmia-related mortality, extracorporeal membrane oxygenation support and/or extracorporeal cardiopulmonary resuscitation should be considered in the management of hemodynamically unstable primary arrhythmias as an emergent lifesaving procedure.",
keywords = "ablation, congenital heart block, extracorporeal membrane oxygenation, infants, intractable arrhythmias, septos-tomy",
author = "Umesh Dyamenahalli and Volkan Tuzcu and Eudice Fontenot and John Papagiannis and Rdb Jaquiss and Adnan Bhutta and Morrow, {William R.} and Erickson, {Christopher C.} and Michiaki Imamura and Parthak Prodhan",
year = "2012",
month = "1",
day = "1",
doi = "10.1097/PCC.0b013e3182196cb1",
language = "English (US)",
volume = "13",
pages = "47--52",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Extracorporeal membrane oxygenation support for intractable primary arrhythmias and complete congenital heart block in newborns and infants

T2 - Short-term and medium-term outcomes

AU - Dyamenahalli, Umesh

AU - Tuzcu, Volkan

AU - Fontenot, Eudice

AU - Papagiannis, John

AU - Jaquiss, Rdb

AU - Bhutta, Adnan

AU - Morrow, William R.

AU - Erickson, Christopher C.

AU - Imamura, Michiaki

AU - Prodhan, Parthak

PY - 2012/1/1

Y1 - 2012/1/1

N2 - OBJECTIVES:: To describe the experience with extracorporeal membrane oxygenation support for intractable primary arrhythmias in newborns and infants. DESIGN:: Retrospective study. SETTING:: A tertiary care pediatric hospital. PATIENTS:: Patients younger than 1 yr supported with extracorporeal membrane oxygenation for primary cardiac arrhythmias were identified from the institutional extracorporeal membrane oxygenation registry. INTERVENTIONS:: Extracorporeal membrane oxygenation support. MEASUREMENTS AND MAIN RESULTS:: Clinical characteristics and outcomes were investigated for patients with primary cardiac arrhythmia supported with extracorporeal membrane oxygenation. Outcomes investigated were time from initiation of extracorporeal membrane oxygenation support to arrhythmia control, duration of extracorporeal membrane oxygenation support, and results of interventions performed while supported with extracorporeal membrane oxygenation. We summarized the independent categorical and continuous variables using frequencies, percentages, and medians and ranges, respectively. Extracorporeal membrane oxygenation support was used in nine patients for rescue therapy for primary tachyarrhythmia and bradycardia. The primary arrhythmias were: focal atrial tachycardia (n = 2); reentrant supraventricular tachycardia (n = 3); junctional ectopic tachycardia (n = 2); and congenital complete atrioventricular block (n = 2) patients. Seven patients presented with severe hemodynamic compromise, with six patients requiring extracorporeal cardiopulmonary resuscitation. All patients required extracorporeal membrane oxygenation within 24 hrs of initial presentation. Balloon atrial septostomy was performed in three patients and ablation was performed in two patients. Sinus rhythm was achieved in all reentrant supraventricular tachycardia and rate control was established in both patients with focal atrial tachycardia and in one patient with junctional ectopic tachycardia while using extracorporeal membrane oxygenation support. All patients survived to hospital discharge, and median follow-up for the cohort was 5 yrs. There was one late death; all survivors had good overall and neurologic outcomes. CONCLUSIONS:: The requirement of extracorporeal membrane oxygenation support in newborns and infants with intractable arrhythmia is rare. Extracorporeal membrane oxygenation support does potentially carry morbidity; however, to prevent arrhythmia-related mortality, extracorporeal membrane oxygenation support and/or extracorporeal cardiopulmonary resuscitation should be considered in the management of hemodynamically unstable primary arrhythmias as an emergent lifesaving procedure.

AB - OBJECTIVES:: To describe the experience with extracorporeal membrane oxygenation support for intractable primary arrhythmias in newborns and infants. DESIGN:: Retrospective study. SETTING:: A tertiary care pediatric hospital. PATIENTS:: Patients younger than 1 yr supported with extracorporeal membrane oxygenation for primary cardiac arrhythmias were identified from the institutional extracorporeal membrane oxygenation registry. INTERVENTIONS:: Extracorporeal membrane oxygenation support. MEASUREMENTS AND MAIN RESULTS:: Clinical characteristics and outcomes were investigated for patients with primary cardiac arrhythmia supported with extracorporeal membrane oxygenation. Outcomes investigated were time from initiation of extracorporeal membrane oxygenation support to arrhythmia control, duration of extracorporeal membrane oxygenation support, and results of interventions performed while supported with extracorporeal membrane oxygenation. We summarized the independent categorical and continuous variables using frequencies, percentages, and medians and ranges, respectively. Extracorporeal membrane oxygenation support was used in nine patients for rescue therapy for primary tachyarrhythmia and bradycardia. The primary arrhythmias were: focal atrial tachycardia (n = 2); reentrant supraventricular tachycardia (n = 3); junctional ectopic tachycardia (n = 2); and congenital complete atrioventricular block (n = 2) patients. Seven patients presented with severe hemodynamic compromise, with six patients requiring extracorporeal cardiopulmonary resuscitation. All patients required extracorporeal membrane oxygenation within 24 hrs of initial presentation. Balloon atrial septostomy was performed in three patients and ablation was performed in two patients. Sinus rhythm was achieved in all reentrant supraventricular tachycardia and rate control was established in both patients with focal atrial tachycardia and in one patient with junctional ectopic tachycardia while using extracorporeal membrane oxygenation support. All patients survived to hospital discharge, and median follow-up for the cohort was 5 yrs. There was one late death; all survivors had good overall and neurologic outcomes. CONCLUSIONS:: The requirement of extracorporeal membrane oxygenation support in newborns and infants with intractable arrhythmia is rare. Extracorporeal membrane oxygenation support does potentially carry morbidity; however, to prevent arrhythmia-related mortality, extracorporeal membrane oxygenation support and/or extracorporeal cardiopulmonary resuscitation should be considered in the management of hemodynamically unstable primary arrhythmias as an emergent lifesaving procedure.

KW - ablation

KW - congenital heart block

KW - extracorporeal membrane oxygenation

KW - infants

KW - intractable arrhythmias

KW - septos-tomy

UR - http://www.scopus.com/inward/record.url?scp=84855683615&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84855683615&partnerID=8YFLogxK

U2 - 10.1097/PCC.0b013e3182196cb1

DO - 10.1097/PCC.0b013e3182196cb1

M3 - Article

C2 - 21516054

AN - SCOPUS:84855683615

VL - 13

SP - 47

EP - 52

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

SN - 1529-7535

IS - 1

ER -