Interhospital transport of children requiring extracorporeal membrane oxygenation support for cardiac dysfunction

Antonio G. Cabrera, Parthak Prodhan, Mario A. Cleves, Richard T. Fiser, Michael Schmitz, Eudice Fontenot, Wesley Mckamie, Carl Chipman, Robert D.B. Jaquiss, Michiaki Imamura

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objective. Many centers are able to emergently deploy extracorporeal membrane oxygenation (ECMO) as support in children with refractory hemodynamic instability, but may be limited in their ability to provide prolonged circulatory support or cardiac transplantation. Such patients may require interhospital transport while on ECMO (cardiac mobile [CM]-ECMO) for additional hemodynamic support or therapy. There are only three centers in the United States that routinely perform CM-ECMO. Our center has a 20-year experience in carrying out such transports. The purpose of this study was twofold: (1) to review our experience with pediatric cardiac patients undergoing CM-ECMO and (2) identify risk factors for a composite outcome (defined as either cardiac transplantation or death) among children undergoing CM-ECMO. Design. Retrospective case series. Setting. Cardiovascular intensive care and pediatric transport system. Patients. Children (n = 37) from 0-18 years undergoing CM-ECMO transports (n = 38) between January 1990 and September 2005. Interventions. None. Measurements and Main Results. A total of 38 CM-ECMO transports were performed for congenital heart disease (n = 22), cardiomyopathy (n = 11), and sepsis with myocardial dysfunction (n = 4). There were 18 survivors to hospital discharge. Twenty-two patients were transported a distance of more than 300 miles from our institution. Ten patients were previously cannulated and on ECMO prior to transport. Thirty-five patients were transported by air and two by ground. Six patients underwent cardiac transplantation, all of whom survived to discharge. After adjusting for other covariates post-CM-ECMO renal support was the only variable associated with the composite outcome of death/need for cardiac transplant (odds ratio = 13.2; 95% confidence interval, 1.60-108.90; P= 0.003). There were two minor complications (equipment failure/dysfunction) and no major complications or deaths during transport. Conclusions. Air and ground CM-ECMO transport of pediatric patients with refractory myocardial dysfunction is safe and effective. In our study cohort, the need for post-CM-ECMO renal support was associated with the composite outcome of death/need for cardiac transplant.

Original languageEnglish (US)
Pages (from-to)202-208
Number of pages7
JournalCongenital Heart Disease
Volume6
Issue number3
DOIs
StatePublished - May 1 2011

Fingerprint

Extracorporeal Membrane Oxygenation
Heart Transplantation
Pediatrics
Hemodynamics
Air
Equipment Failure
Transplants
Kidney
Critical Care
Cardiomyopathies
Survivors
Heart Diseases
Sepsis
Cohort Studies
Odds Ratio

Keywords

  • Cardiac
  • Children
  • ECMO
  • Mobile
  • Transplant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Cabrera, A. G., Prodhan, P., Cleves, M. A., Fiser, R. T., Schmitz, M., Fontenot, E., ... Imamura, M. (2011). Interhospital transport of children requiring extracorporeal membrane oxygenation support for cardiac dysfunction. Congenital Heart Disease, 6(3), 202-208. https://doi.org/10.1111/j.1747-0803.2011.00506.x

Interhospital transport of children requiring extracorporeal membrane oxygenation support for cardiac dysfunction. / Cabrera, Antonio G.; Prodhan, Parthak; Cleves, Mario A.; Fiser, Richard T.; Schmitz, Michael; Fontenot, Eudice; Mckamie, Wesley; Chipman, Carl; Jaquiss, Robert D.B.; Imamura, Michiaki.

In: Congenital Heart Disease, Vol. 6, No. 3, 01.05.2011, p. 202-208.

Research output: Contribution to journalArticle

Cabrera, AG, Prodhan, P, Cleves, MA, Fiser, RT, Schmitz, M, Fontenot, E, Mckamie, W, Chipman, C, Jaquiss, RDB & Imamura, M 2011, 'Interhospital transport of children requiring extracorporeal membrane oxygenation support for cardiac dysfunction', Congenital Heart Disease, vol. 6, no. 3, pp. 202-208. https://doi.org/10.1111/j.1747-0803.2011.00506.x
Cabrera, Antonio G. ; Prodhan, Parthak ; Cleves, Mario A. ; Fiser, Richard T. ; Schmitz, Michael ; Fontenot, Eudice ; Mckamie, Wesley ; Chipman, Carl ; Jaquiss, Robert D.B. ; Imamura, Michiaki. / Interhospital transport of children requiring extracorporeal membrane oxygenation support for cardiac dysfunction. In: Congenital Heart Disease. 2011 ; Vol. 6, No. 3. pp. 202-208.
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AU - Fontenot, Eudice

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N2 - Objective. Many centers are able to emergently deploy extracorporeal membrane oxygenation (ECMO) as support in children with refractory hemodynamic instability, but may be limited in their ability to provide prolonged circulatory support or cardiac transplantation. Such patients may require interhospital transport while on ECMO (cardiac mobile [CM]-ECMO) for additional hemodynamic support or therapy. There are only three centers in the United States that routinely perform CM-ECMO. Our center has a 20-year experience in carrying out such transports. The purpose of this study was twofold: (1) to review our experience with pediatric cardiac patients undergoing CM-ECMO and (2) identify risk factors for a composite outcome (defined as either cardiac transplantation or death) among children undergoing CM-ECMO. Design. Retrospective case series. Setting. Cardiovascular intensive care and pediatric transport system. Patients. Children (n = 37) from 0-18 years undergoing CM-ECMO transports (n = 38) between January 1990 and September 2005. Interventions. None. Measurements and Main Results. A total of 38 CM-ECMO transports were performed for congenital heart disease (n = 22), cardiomyopathy (n = 11), and sepsis with myocardial dysfunction (n = 4). There were 18 survivors to hospital discharge. Twenty-two patients were transported a distance of more than 300 miles from our institution. Ten patients were previously cannulated and on ECMO prior to transport. Thirty-five patients were transported by air and two by ground. Six patients underwent cardiac transplantation, all of whom survived to discharge. After adjusting for other covariates post-CM-ECMO renal support was the only variable associated with the composite outcome of death/need for cardiac transplant (odds ratio = 13.2; 95% confidence interval, 1.60-108.90; P= 0.003). There were two minor complications (equipment failure/dysfunction) and no major complications or deaths during transport. Conclusions. Air and ground CM-ECMO transport of pediatric patients with refractory myocardial dysfunction is safe and effective. In our study cohort, the need for post-CM-ECMO renal support was associated with the composite outcome of death/need for cardiac transplant.

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