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Extracorporeal membrane oxygenation: a bridge to palliation in single ventricle physiology

Published online by Cambridge University Press:  21 March 2025

Ivana Capin Open the ORCID record for Ivana Capin [Opens in a new window] ,
George Ofori-Amanfo ,
Maria Esperanza ,
Raghav Murthy ,
Gary Oldenburg ,
Jacqueline M. Lamour ,
Kristi Glotzbach  and
Scott I. Aydin
Ivana Capin*
Affiliation:
Division of Pediatric Critical Care, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine, New York, USA
George Ofori-Amanfo
Affiliation:
Division of Pediatric Critical Care, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine, New York, USA
Maria Esperanza
Affiliation:
Division of Pediatric Critical Care, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine, New York, USA
Raghav Murthy
Affiliation:
Division of Cardiovascular Surgery, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine, New York, USA
Gary Oldenburg
Affiliation:
Division of Respiratory Therapy, Mount Sinai Hospital, Division of Pediatric Critical Care, New York, USA
Jacqueline M. Lamour
Affiliation:
Division of Pediatric Cardiology, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine, New York, USA
Kristi Glotzbach
Affiliation:
Division of Pediatric Critical Care, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA
Scott I. Aydin
Affiliation:
Division of Pediatric Critical Care, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine, New York, USA
*
Corresponding author: Ivana Capin; Email: [email protected]
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Abstract

Objective:

To evaluate the outcomes of patients with single ventricle physiology supported with extracorporeal membrane oxygenation as a bridge to first-stage palliation.

Methods:

This was a retrospective registry-based study. Data from the Extracorporeal Life Support Organization registry were used to identify single ventricle physiology patients supported with extracorporeal membrane oxygenation prior to palliation from 2016 to 2021. Descriptive statistics and multivariate analyses for associations with mortality were conducted.

Results:

Primary outcome was death before hospital discharge. Patient characteristics including demographics and associated complications were evaluated as secondary outcomes. Sixty-five patients met inclusion criteria. Survival to discharge was 42%. Twenty-four (37%) patients died while on extracorporeal membrane oxygenation. There was no significant difference in demographics between survivors and non-survivors. Non-survivors had a significantly longer median duration on extracorporeal membrane oxygenation compared to survivors, 99-hrs [IQR (Interquartile Range), 160, 300] vs. 59-hrs [43, 124] (p<0.001). Multivariate analysis demonstrated extracorporeal membrane oxygenation duration (adjusted-OR [Odds Ratio] 1.01, 95% CI [Confidence Interval] 0.98, 0.99; p = 0.03) and requiring renal replacement therapy (42% vs. 19%; p = 0.04) were associated with mortality prior to discharge.

Conclusions:

Clinicians managing decompensated patients with single ventricle physiology may consider extracorporeal membrane oxygenation as a bridge to palliation. Survival to discharge was 42%. Evidence of renal injury and longer extracorporeal membrane oxygenation durations were associated with mortality. These data may be used to guide providers and to counsel families. However, more data are needed to refine indications and assess associations related to outcomes and decision-making.

Keywords

extracorporeal membrane oxygenationsingle ventricle physiologycongenitalmortalitysurvivorship
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 6
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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