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Extracorporeal Membrane Oxygenation in Children with Heart Disease and Down Syndrome: A Multicenter Analysis

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Abstract

The data on the outcomes of children with heart disease and Down syndrome receiving extracorporeal membrane oxygenation (ECMO) for cardiac or respiratory failure are limited. This study aimed to evaluate morbidity and mortality associated with ECMO in children with Down syndrome and heart disease. Children younger than 18 years undergoing heart surgery and ECMO reported in the Extracorporeal Life Support Organization (ELSO) registry (1998–2011) were included in the study. The registry was queried for the following five heart defects: common atrioventricular (AV) canal, tetralogy of Fallot, truncus arteriosus, transposition of great vessels, and interrupted aortic arch. Data collection included patient characteristics, ECMO characteristics, and outcomes. The outcomes evaluated included mortality, ECMO duration, and length of hospital stay for patients with Down syndrome and those with no Down syndrome. The study enrolled 2,815 patients qualified for inclusion. Of these patients, 121 had Down syndrome, whereas 2,694 had no genetic syndrome and were included in the control group. The median age of the patients was 45 days (interquartile range [IQR] 9–192 days), and the median weight was 3.8 kg (IQR 3.0–6.1 kg). The most common cardiac defects in Down syndrome group were common AV canal (63 %) and tetralogy of Fallot (40 %). The Down syndrome group included older patients with greater body weight than the control group. The mortality rate was lower in the Down syndrome group than in the control group (44 vs. 56 %; p = 0.01). The duration of ECMO and length of hospital stay were similar in the two groups. The findings showed that ECMO can be used for children with heart disease and Down syndrome with good results. The outcomes were comparable between the children with Down syndrome and the children without Down syndrome.

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References

  1. Alsoufi B, Al-Radi OO, Gruenwald C, Lean L, Williams WG, McCrindle BW et al (2009) Extracorporeal life support following cardiac surgery in children: analysis of risk factors and survival in a single institution. Eur J Cardiothorac Surg 35:1004–1011

    Article  PubMed  Google Scholar 

  2. Baffes TG, Fridman JL, Bicoff JP, Whitehill JL (1970) Extracorporeal circulation for support of palliative cardiac surgery in infants. Ann Thorac Surg 4:354–363

  3. Black MD, Coles JG, Williams WG, Rebeyka IM, Trusler GA, Bohn D et al (1995) Determinants of success in pediatric cardiac patients undergoing extracorporeal membrane oxygenation. Ann Thorac Surg 60:133–138

    Article  CAS  PubMed  Google Scholar 

  4. Boneva RS, Botto LD, Moore CA, Yang Q, Correa A, Erickson JD (2001) Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979–1997. Circulation 103:2376–2381

    Article  CAS  PubMed  Google Scholar 

  5. Carmichael TB, Walsh EP, Roth SJ (2002) Anticipatory use of venoarterial extracorporeal membrane oxygenation for a high-risk interventional cardiac procedure. Respir Care 47:1002–1006

    PubMed  Google Scholar 

  6. Chapman RL, Peterec SM, Bizzarro MJ, Mercurio MR (2009) Patient selection for neonatal extracorporeal membrane oxygenation: beyond severity of illness. J Perinatol 29:606–611

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Chaturvedi RR, Macrae D, Brown KL, Schindler M, Smith EC, Davis KB et al (2004) Cardiac extracorporeal membrane oxygenation for biventricular hearts after paediatric open heart surgery. Heart 90:545–551

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Cullen SM, Cronk CE, Pueschel SM, Schnell RR, Reed RB (1981) Social development and feeding milestones of young down syndrome children. Am J Ment Defic 85:410–415

    CAS  PubMed  Google Scholar 

  9. Duncan BW, Hraska V, Jonas RA, Wessel DL, Del Nido PJ, Laussen PC et al (1999) Mechanical circulatory support in children with cardiac disease. J Thorac Cardiovasc Surg 117:529–542

    Article  CAS  PubMed  Google Scholar 

  10. ELSO: Registry Report of the Extracorporeal Life Support Organization (2012) International Summary. Ann Arbor

  11. Fudge JC Jr, Li S, Jaggers J, O’Brien SM, Peterson ED, Jacobs JP et al (2010) Congenital heart surgery outcomes in down syndrome: analysis of a national clinical database. Pediatrics 126(2):315–322

    Article  PubMed Central  PubMed  Google Scholar 

  12. Gupta P, McDonald R, Chipman CW, Stroud M, Gossett JM, Imamura M, Bhutta AT (2012) 20-Year experience of prolonged extracorporeal membrane oxygenation in critically ill children with cardiac or pulmonary failure. Ann Thorac Surg 93:1584–1590

    Article  PubMed  Google Scholar 

  13. Kane DA, Thiagarajan RR, Wypij D, Scheurer MA, Fynn-Thompson F, Emani S, del Nido PJ, Betit P, Laussen PC (2010) Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 122:S241–S248

    Article  CAS  PubMed  Google Scholar 

  14. Kolovos NS, Bratton SL, Moler FW, Bove EL, Ohye RG, Bartlett RH et al (2003) Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery. Ann Thorac Surg 76:1435–1441

    Article  PubMed  Google Scholar 

  15. Kulik TJ, Moler FW, Palmisano JM, Custer JR, Mosca RS, Bove EL et al (1996) Outcome associated factors in pediatric patients treated with extracorporeal membrane oxygenator after cardiac surgery. Circulation 94:63–68

    Google Scholar 

  16. Pierpont ME, Basson CT, Benson DW Jr, Gelb BD, Giglia TM, Goldmuntz E et al (2007) Genetic basis for congenital heart defects: current knowledge. Circulation 115:3015–3038

    Article  PubMed  Google Scholar 

  17. Ravishankar C, Dominguez TE, Kreutzer J, Wernovsky G, Marino BS, Godinez R et al (2006) Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome. Pediatr Crit Care Med 7:319–326

    Article  PubMed  Google Scholar 

  18. Reller MD, Morris CD (1998) Is Down syndrome a risk factor for poor outcome after repair of congenital heart defects? J Pediatr 132:738–741

    Article  CAS  PubMed  Google Scholar 

  19. Shen I, Ungerleider RM (2004) Routine use of mechanical ventricular assist following the Norwood procedure. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 7:16–721

    Article  PubMed  Google Scholar 

  20. Simsic JM, Coleman K, Maher KO, Cuadrado A, Kirshbom PM (2009) Do neonates with genetic abnormalities have an increased morbidity and mortality following cardiac surgery? Congenit Heart Dis 4:160–165

    Article  PubMed  Google Scholar 

  21. Southgate WM, Annibale DJ, Husley TC, Purohit DM (2001) International experience with trisomy 21 infants placed on extracorporeal membrane oxygenation. Pediatrics 107:549–552

    Article  CAS  PubMed  Google Scholar 

  22. Ungerleider RM, Shen I, Yeh T et al (2004) Routine mechanical ventricular assist following the Norwood procedure: improved neurologic outcome and excellent hospital survival. Ann Thorac Surg 77:18–22

    Article  PubMed  Google Scholar 

  23. Uppu SC, Goyal S, Gossett JM, Yan K, Dao DT, Fontenot EE, Imamura M, Gupta P (2013) Extracorporeal membrane oxygenation in children with heart disease and genetic syndromes. ASAIO J 59:52–56

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Sections of Pediatric Cardiology and Critical Care Medicine, Division of Pediatric Cardiology, Department of Pediatrics, Arkansas Children’s Hospital, College of Medicine, University of Arkansas for Medical Sciences, 1 Children’s Way, Slot 512-3, Little Rock, AR, USA

    Punkaj Gupta & Parthak Prodhan

  2. Division of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Punkaj Gupta & Parthak Prodhan

  3. Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Jeffrey M. Gossett

  4. Extracorporeal Life Support Organization, University of Michigan, Ann Arbor, MI, USA

    Peter T. Rycus

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  1. Punkaj Gupta
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  2. Jeffrey M. Gossett
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  3. Peter T. Rycus
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  4. Parthak Prodhan
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Correspondence to Punkaj Gupta.

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Gupta, P., Gossett, J.M., Rycus, P.T. et al. Extracorporeal Membrane Oxygenation in Children with Heart Disease and Down Syndrome: A Multicenter Analysis. Pediatr Cardiol 35, 1421–1428 (2014). https://doi.org/10.1007/s00246-014-0945-z

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  • DOI: https://doi.org/10.1007/s00246-014-0945-z

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