Researchers have reported preliminary results from a multicenter study aimed at better understanding and improving outcomes for children with cardiovascular disease who are critically ill and require emergency mechanical circulatory support.
The study analyzes data from 23 children’s hospitals across the country and their use of extracorporeal membrane oxygenation (ECMO) in children cared for in the cardiac intensive care unit. Morbidity and mortality rates for children with cardiovascular disease requiring ECMO to support their heart and lungs remain exceptionally high.
The study was presented as a featured abstract recently at the American College of Cardiology Scientific Session in Washington D.C. The research was initiated by researchers at the Children’s Hospital of Philadelphia and done in conjunction with the Pediatric Cardiac Critical Care Consortium (PC4) based out of the University of Michigan. PC4 is a multicenter quality improvement and research collaborative geared toward improving pediatric cardiac critical care outcomes.
“ECMO is a therapy used to rescue the sickest of children,” said Marissa Brunetti, MD, lead author of the study and a pediatric intensivist at Children’s Hospital of Philadelphia. “We wanted to understand how often it is used across the country, which patients are highest risk for needing ECMO, and what the outcomes are, so that we can anticipate patient care and work to improve outcomes.”
“The use of ECMO in critically ill children with cardiac disease is rare, but the risk of mortality is much too high. There may be opportunities to improve these outcomes by understanding the practices of top performing hospitals that either avoid ECMO altogether or achieve the best results for patients who do require this therapy” says the study’s senior author Michael Gaies, MD, a pediatric cardiologist at University of Michigan’s C.S. Mott Children’s Hospital and Executive Director of PC4.
An estimated 50 to 80 percent of children with cardiac disease sustained by ECMO in the cardiac intensive unit die every year. Complications associated with ECMO include bleeding, infections, organ failure, and brain injury, along with high cost.
The study has already identified several high-risk subgroups within medical and surgical patients to target for quality initiatives. Non-surgical cardiac patients with acute heart failure symptoms have a high risk of needing ECMO. Risk factors for surgical patients include younger age, higher severity of illness before surgery, and surgical complexity. Researchers also found that ECMO utilization rates after cardiac surgery differ significantly across hospitals, with some hospitals using ECMO much less and others much more frequently than would be expected after surgery.
Prior to this study, the risk factors and outcomes of ECMO therapy had not been fully described in a population of patients with non-surgical cardiovascular disease, and the differing use across hospitals after surgery has not been previously reported.