Relationship Between Time to Left Atrial Decompression and Outcomes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support

A Multicenter Pediatric Interventional Cardiology Early-Career Society Study

Jeffrey D. Zampi, Fares Alghanem, Sunkyung Yu, Ryan Callahan, Christopher L. Curzon, Jeffrey W. Delaney, Robert G. Gray, Carrie E. Herbert, Ryan A. Leahy, Ray Lowery, Sara K. Pasquali, Priti M. Patel, Diego Porras, Shabana Shahanavaz, Ravi R. Thiagarajan, Sara M. Trucco, Mariel E. Turner, Surendranath R Veeram Reddy, Shawn C. West, Wendy Whiteside & 1 others Bryan H. Goldstein

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: To assess the variation in timing of left atrial decompression and its association with clinical outcomes in pediatric patients supported with venoarterial extracorporeal membrane oxygenation across a multicenter cohort. DESIGN: Multicenter retrospective study. SETTING: Eleven pediatric hospitals within the United States. PATIENTS: Patients less than 18 years on venoarterial extracorporeal membrane oxygenation who underwent left atrial decompression from 2004 to 2016.None. MEASUREMENTS AND MAIN RESULTS: A total of 137 patients (median age, 4.7 yr) were included. Cardiomyopathy was the most common diagnosis (47%). Cardiac arrest (39%) and low cardiac output (50%) were the most common extracorporeal membrane oxygenation indications. Median time to left atrial decompression was 6.2 hours (interquartile range, 3.8-17.2 hr) with the optimal cut-point of greater than or equal to 18 hours for late decompression determined by receiver operating characteristic curve. In univariate analysis, late decompression was associated with longer extracorporeal membrane oxygenation duration (median 8.5 vs 5 d; p = 0.02). In multivariable analysis taking into account clinical confounder and center effects, late decompression remained significantly associated with prolonged extracorporeal membrane oxygenation duration (adjusted odds ratio, 4.4; p = 0.002). Late decompression was also associated with longer duration of mechanical ventilation (adjusted odds ratio, 4.8; p = 0.002). Timing of decompression was not associated with in-hospital survival (p = 0.36) or overall survival (p = 0.42) with median follow-up of 3.2 years. CONCLUSIONS: In this multicenter study of pediatric patients receiving venoarterial extracorporeal membrane oxygenation, late left atrial decompression (≥ 18 hr) was associated with longer duration of extracorporeal membrane oxygenation support and mechanical ventilation. Although no survival benefit was demonstrated, the known morbidities associated with prolonged extracorporeal membrane oxygenation use may justify a recommendation for early left atrial decompression.

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Extracorporeal Membrane Oxygenation
Decompression
Cardiology
Pediatrics
Artificial Respiration
Multicenter Studies
Survival
Odds Ratio
Low Cardiac Output
Pediatric Hospitals
Heart Arrest
Cardiomyopathies
ROC Curve
Retrospective Studies
Morbidity

ASJC Scopus subject areas

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

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Relationship Between Time to Left Atrial Decompression and Outcomes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support : A Multicenter Pediatric Interventional Cardiology Early-Career Society Study. / Zampi, Jeffrey D.; Alghanem, Fares; Yu, Sunkyung; Callahan, Ryan; Curzon, Christopher L.; Delaney, Jeffrey W.; Gray, Robert G.; Herbert, Carrie E.; Leahy, Ryan A.; Lowery, Ray; Pasquali, Sara K.; Patel, Priti M.; Porras, Diego; Shahanavaz, Shabana; Thiagarajan, Ravi R.; Trucco, Sara M.; Turner, Mariel E.; Veeram Reddy, Surendranath R; West, Shawn C.; Whiteside, Wendy; Goldstein, Bryan H.

In: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, Vol. 20, No. 8, 01.08.2019, p. 728-736.

Research output: Contribution to journalArticle

Zampi, Jeffrey D. ; Alghanem, Fares ; Yu, Sunkyung ; Callahan, Ryan ; Curzon, Christopher L. ; Delaney, Jeffrey W. ; Gray, Robert G. ; Herbert, Carrie E. ; Leahy, Ryan A. ; Lowery, Ray ; Pasquali, Sara K. ; Patel, Priti M. ; Porras, Diego ; Shahanavaz, Shabana ; Thiagarajan, Ravi R. ; Trucco, Sara M. ; Turner, Mariel E. ; Veeram Reddy, Surendranath R ; West, Shawn C. ; Whiteside, Wendy ; Goldstein, Bryan H. / Relationship Between Time to Left Atrial Decompression and Outcomes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support : A Multicenter Pediatric Interventional Cardiology Early-Career Society Study. In: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2019 ; Vol. 20, No. 8. pp. 728-736.
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title = "Relationship Between Time to Left Atrial Decompression and Outcomes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support: A Multicenter Pediatric Interventional Cardiology Early-Career Society Study",
abstract = "OBJECTIVES: To assess the variation in timing of left atrial decompression and its association with clinical outcomes in pediatric patients supported with venoarterial extracorporeal membrane oxygenation across a multicenter cohort. DESIGN: Multicenter retrospective study. SETTING: Eleven pediatric hospitals within the United States. PATIENTS: Patients less than 18 years on venoarterial extracorporeal membrane oxygenation who underwent left atrial decompression from 2004 to 2016.None. MEASUREMENTS AND MAIN RESULTS: A total of 137 patients (median age, 4.7 yr) were included. Cardiomyopathy was the most common diagnosis (47{\%}). Cardiac arrest (39{\%}) and low cardiac output (50{\%}) were the most common extracorporeal membrane oxygenation indications. Median time to left atrial decompression was 6.2 hours (interquartile range, 3.8-17.2 hr) with the optimal cut-point of greater than or equal to 18 hours for late decompression determined by receiver operating characteristic curve. In univariate analysis, late decompression was associated with longer extracorporeal membrane oxygenation duration (median 8.5 vs 5 d; p = 0.02). In multivariable analysis taking into account clinical confounder and center effects, late decompression remained significantly associated with prolonged extracorporeal membrane oxygenation duration (adjusted odds ratio, 4.4; p = 0.002). Late decompression was also associated with longer duration of mechanical ventilation (adjusted odds ratio, 4.8; p = 0.002). Timing of decompression was not associated with in-hospital survival (p = 0.36) or overall survival (p = 0.42) with median follow-up of 3.2 years. CONCLUSIONS: In this multicenter study of pediatric patients receiving venoarterial extracorporeal membrane oxygenation, late left atrial decompression (≥ 18 hr) was associated with longer duration of extracorporeal membrane oxygenation support and mechanical ventilation. Although no survival benefit was demonstrated, the known morbidities associated with prolonged extracorporeal membrane oxygenation use may justify a recommendation for early left atrial decompression.",
author = "Zampi, {Jeffrey D.} and Fares Alghanem and Sunkyung Yu and Ryan Callahan and Curzon, {Christopher L.} and Delaney, {Jeffrey W.} and Gray, {Robert G.} and Herbert, {Carrie E.} and Leahy, {Ryan A.} and Ray Lowery and Pasquali, {Sara K.} and Patel, {Priti M.} and Diego Porras and Shabana Shahanavaz and Thiagarajan, {Ravi R.} and Trucco, {Sara M.} and Turner, {Mariel E.} and {Veeram Reddy}, {Surendranath R} and West, {Shawn C.} and Wendy Whiteside and Goldstein, {Bryan H.}",
year = "2019",
month = "8",
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doi = "10.1097/PCC.0000000000001936",
language = "English (US)",
volume = "20",
pages = "728--736",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
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TY - JOUR

T1 - Relationship Between Time to Left Atrial Decompression and Outcomes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support

T2 - A Multicenter Pediatric Interventional Cardiology Early-Career Society Study

AU - Zampi, Jeffrey D.

AU - Alghanem, Fares

AU - Yu, Sunkyung

AU - Callahan, Ryan

AU - Curzon, Christopher L.

AU - Delaney, Jeffrey W.

AU - Gray, Robert G.

AU - Herbert, Carrie E.

AU - Leahy, Ryan A.

AU - Lowery, Ray

AU - Pasquali, Sara K.

AU - Patel, Priti M.

AU - Porras, Diego

AU - Shahanavaz, Shabana

AU - Thiagarajan, Ravi R.

AU - Trucco, Sara M.

AU - Turner, Mariel E.

AU - Veeram Reddy, Surendranath R

AU - West, Shawn C.

AU - Whiteside, Wendy

AU - Goldstein, Bryan H.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - OBJECTIVES: To assess the variation in timing of left atrial decompression and its association with clinical outcomes in pediatric patients supported with venoarterial extracorporeal membrane oxygenation across a multicenter cohort. DESIGN: Multicenter retrospective study. SETTING: Eleven pediatric hospitals within the United States. PATIENTS: Patients less than 18 years on venoarterial extracorporeal membrane oxygenation who underwent left atrial decompression from 2004 to 2016.None. MEASUREMENTS AND MAIN RESULTS: A total of 137 patients (median age, 4.7 yr) were included. Cardiomyopathy was the most common diagnosis (47%). Cardiac arrest (39%) and low cardiac output (50%) were the most common extracorporeal membrane oxygenation indications. Median time to left atrial decompression was 6.2 hours (interquartile range, 3.8-17.2 hr) with the optimal cut-point of greater than or equal to 18 hours for late decompression determined by receiver operating characteristic curve. In univariate analysis, late decompression was associated with longer extracorporeal membrane oxygenation duration (median 8.5 vs 5 d; p = 0.02). In multivariable analysis taking into account clinical confounder and center effects, late decompression remained significantly associated with prolonged extracorporeal membrane oxygenation duration (adjusted odds ratio, 4.4; p = 0.002). Late decompression was also associated with longer duration of mechanical ventilation (adjusted odds ratio, 4.8; p = 0.002). Timing of decompression was not associated with in-hospital survival (p = 0.36) or overall survival (p = 0.42) with median follow-up of 3.2 years. CONCLUSIONS: In this multicenter study of pediatric patients receiving venoarterial extracorporeal membrane oxygenation, late left atrial decompression (≥ 18 hr) was associated with longer duration of extracorporeal membrane oxygenation support and mechanical ventilation. Although no survival benefit was demonstrated, the known morbidities associated with prolonged extracorporeal membrane oxygenation use may justify a recommendation for early left atrial decompression.

AB - OBJECTIVES: To assess the variation in timing of left atrial decompression and its association with clinical outcomes in pediatric patients supported with venoarterial extracorporeal membrane oxygenation across a multicenter cohort. DESIGN: Multicenter retrospective study. SETTING: Eleven pediatric hospitals within the United States. PATIENTS: Patients less than 18 years on venoarterial extracorporeal membrane oxygenation who underwent left atrial decompression from 2004 to 2016.None. MEASUREMENTS AND MAIN RESULTS: A total of 137 patients (median age, 4.7 yr) were included. Cardiomyopathy was the most common diagnosis (47%). Cardiac arrest (39%) and low cardiac output (50%) were the most common extracorporeal membrane oxygenation indications. Median time to left atrial decompression was 6.2 hours (interquartile range, 3.8-17.2 hr) with the optimal cut-point of greater than or equal to 18 hours for late decompression determined by receiver operating characteristic curve. In univariate analysis, late decompression was associated with longer extracorporeal membrane oxygenation duration (median 8.5 vs 5 d; p = 0.02). In multivariable analysis taking into account clinical confounder and center effects, late decompression remained significantly associated with prolonged extracorporeal membrane oxygenation duration (adjusted odds ratio, 4.4; p = 0.002). Late decompression was also associated with longer duration of mechanical ventilation (adjusted odds ratio, 4.8; p = 0.002). Timing of decompression was not associated with in-hospital survival (p = 0.36) or overall survival (p = 0.42) with median follow-up of 3.2 years. CONCLUSIONS: In this multicenter study of pediatric patients receiving venoarterial extracorporeal membrane oxygenation, late left atrial decompression (≥ 18 hr) was associated with longer duration of extracorporeal membrane oxygenation support and mechanical ventilation. Although no survival benefit was demonstrated, the known morbidities associated with prolonged extracorporeal membrane oxygenation use may justify a recommendation for early left atrial decompression.

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U2 - 10.1097/PCC.0000000000001936

DO - 10.1097/PCC.0000000000001936

M3 - Article

VL - 20

SP - 728

EP - 736

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

SN - 1529-7535

IS - 8

ER -