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Hemorrhagic Complications in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation: An Analysis of the Extracorporeal Life Support Organization Registry
Hemorrhagic Complications in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation: An Analysis of the Extracorporeal Life Support Organization Registry
- Publication Year :
- 2015
-
Abstract
- To determine the prevalence of and risk factors for hemorrhagic complications in children with cardiac disease requiring extracorporeal membrane oxygenation.Retrospective review of the Extracorporeal Life Support Organization Registry (2002-2013).Participating Extracorporeal Life Support Organization centers.Patients less than 18 years old on extracorporeal membrane oxygenation.None.Of 21,845 patients requiring extracorporeal membrane oxygenation during the study period, 8,905 (41%) had cardiac disease, and 79% of whom (6,995) had cardiac surgery. Hemorrhagic complications occurred in 8,480 patients (39% of overall cohort), with higher rates in cardiac versus noncardiac patients (49% vs 32%; p0.0001) related to cannulation and surgical site bleeding. Cardiac surgical patients had higher rates of hemorrhage compared with cardiac medical patients (57% vs 38%; p0.0001), and cardiac patients with hemorrhage had higher extracorporeal membrane oxygenation mortality compared with those without (42% vs 22% in medical patients and 34% vs 20% in surgical patients; both p0.0001). In multivariable analysis in both the cardiac medical and surgical groups, hemorrhage risk was higher in children greater than 1 year old and in patients with longer extracorporeal membrane oxygenation duration. Additional independent risk factors for hemorrhage in cardiac surgical patients included pre-extracorporeal membrane oxygenation mediastinal exploration (odds ratio, 3.6; 95% CI, 2.1-6.3), Society of Thoracic Surgeons morbidity category 4-5 (odds ratio, 1.2; 95% CI, 1.03-1.5), cannulation less than 24 hours after surgery (odds ratio, 1.6; 95% CI, 1.3-1.9), and longer cardiopulmonary bypass time (≥ 282 min [upper quartile]; odds ratio, 1.5; 95% CI, 1.3-1.9).In this large, multicenter analysis, hemorrhagic complications occurred in nearly half of children with heart disease on extracorporeal membrane oxygenation and were associated with a significant mortality risk. Several factors were associated with hemorrhagic complications in cardiac surgical patients including pre-extracorporeal membrane oxygenation mediastinal exploration, greater surgical complexity, early postoperative cannulation, and longer bypass times. Whether these risks can be mitigated by modifying or delaying systemic anticoagulation requires further investigation.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Adolescent
Heart Diseases
medicine.medical_treatment
Treatment outcome
Hemorrhage
Disease
Critical Care and Intensive Care Medicine
Extracorporeal
Article
law.invention
Extracorporeal Membrane Oxygenation
Postoperative Complications
law
Risk Factors
Cardiopulmonary bypass
Extracorporeal membrane oxygenation
Prevalence
Medicine
Humans
Hospital Mortality
Registries
Cardiac Surgical Procedures
Intensive care medicine
Child
Retrospective Studies
Cardiopulmonary Bypass
business.industry
Infant
Retrospective cohort study
Treatment Outcome
Hemorrhagic complication
Life support
Child, Preschool
Pediatrics, Perinatology and Child Health
Female
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....c9cf2c670c88b8095cc2f368f0644ca4