TY  - EJOU
AU  - Dolgner, Stephen J. 
AU  - Krieger, Eric V. 
AU  - Wilkes, Jacob 
AU  - Bratton, Susan L. 
AU  - Thiagarajan, Ravi R. 
AU  - Barrett, Cindy S. 
AU  - Chan, Titus 

TI  - Predictors of extracorporeal membrane oxygenation support after surgery for adult congenital heart disease in children’s hospitals
T2  - Structural and Congenital Heart Disease

PY  - 2019
VL  - 14
IS  - 4
SN  - 3071-1738

AB  - <b>Objective:</b> Adult congenital heart disease (ACHD) patients who undergo cardiac surgery are at risk for poor outcomes, including extracorporeal membrane oxygenation
support (ECMO) and death. Prior studies have demonstrated risk factors for mortality, but have not fully examined risk factors for ECMO or death without ECMO
(DWE). We sought to identify risk factors for ECMO and DWE in adults undergoing
congenital heart surgery in tertiary care children’s hospitals.<br/>
<b>Design:</b> All adults (≥18 years) undergoing congenital heart surgery in the Pediatric
Health Information System (PHIS) database between 2003 and 2014 were included.
Patients were classified into three groups: ECMO‐free survival, requiring ECMO, and
DWE. Univariate analyses were performed, and multinomial logistic regression models were constructed examining ECMO and DWE as independent outcomes.<br/>
<b>Setting:</b> Tertiary care children’s hospitals.<br/>
<b>Results:</b> A total of 4665 adult patients underwent ACHD surgery in 39 children’s
hospitals with 51 (1.1%) patients requiring ECMO and 64 (1.4%) patients experiencing
DWE. Of the 51 ECMO patients, 34 (67%) died. Increasing patient age, surgical complexity, diagnosis of single ventricle heart disease, preoperative hospitalization, and
the presence of noncardiac complex chronic conditions (CCC) were risk factors for
both outcomes. Additionally, low and medium hospital ACHD surgical volume was
associated with an increased risk of DWE in comparison with ECMO.<br/>
<b>Conclusions:</b> There are overlapping but separate risk factors for ECMO support and
DWE among adults undergoing congenital heart surgery in pediatric hospitals.
KW  - adult congenital heart disease
KW  -  congenital heart surgery
KW  -  extracorporeal membrane oxygenation

DO  - 10.1111/chd.12758