| Interhospital transport of children requiring extracorporeal membrane oxygenation support for cardiac dysfunction. | |
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MedLine Citation:
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PMID: 21450033 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Many centers are able to emergently deploy extracorporeal membrane oxygenation (ECMO) as support in children with refractory hemodynamic instability, but may be limited in their ability to provide prolonged circulatory support or cardiac transplantation. Such patients may require interhospital transport while on ECMO (cardiac mobile [CM]-ECMO) for additional hemodynamic support or therapy. There are only three centers in the United States that routinely perform CM-ECMO. Our center has a 20-year experience in carrying out such transports. The purpose of this study was twofold: (1) to review our experience with pediatric cardiac patients undergoing CM-ECMO and (2) identify risk factors for a composite outcome (defined as either cardiac transplantation or death) among children undergoing CM-ECMO. DESIGN: Retrospective case series. SETTING: Cardiovascular intensive care and pediatric transport system. PATIENTS: Children (n = 37) from 0-18 years undergoing CM-ECMO transports (n = 38) between January 1990 and September 2005. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 38 CM-ECMO transports were performed for congenital heart disease (n = 22), cardiomyopathy (n = 11), and sepsis with myocardial dysfunction (n = 4). There were 18 survivors to hospital discharge. Twenty-two patients were transported a distance of more than 300 miles from our institution. Ten patients were previously cannulated and on ECMO prior to transport. Thirty-five patients were transported by air and two by ground. Six patients underwent cardiac transplantation, all of whom survived to discharge. After adjusting for other covariates post-CM-ECMO renal support was the only variable associated with the composite outcome of death/need for cardiac transplant (odds ratio = 13.2; 95% confidence interval, 1.60--108.90; P = 0.003). There were two minor complications (equipment failure/dysfunction) and no major complications or deaths during transport. CONCLUSIONS: Air and ground CM-ECMO transport of pediatric patients with refractory myocardial dysfunction is safe and effective. In our study cohort, the need for post-CM-ECMO renal support was associated with the composite outcome of death/need for cardiac transplant. |
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Authors:
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Antonio G Cabrera; Parthak Prodhan; Mario A Cleves; Richard T Fiser; Michael Schmitz; Eudice Fontenot; Wesley McKamie; Carl Chipman; Robert D B Jaquiss; Michiaki Imamura |
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Publication Detail:
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Type: Journal Article Date: 2011-03-31 |
Journal Detail:
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Title: Congenital heart disease Volume: 6 ISSN: 1747-0803 ISO Abbreviation: Congenit Heart Dis Publication Date: 2011 May-Jun |
Date Detail:
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Created Date: 2011-05-23 Completed Date: 2011-09-16 Revised Date: 2012-01-09 |
Medline Journal Info:
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Nlm Unique ID: 101256510 Medline TA: Congenit Heart Dis Country: United States |
Other Details:
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Languages: eng Pagination: 202-8 Citation Subset: IM |
Copyright Information:
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© 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc. |
Affiliation:
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Department of Pediatrics, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Air Ambulances Ambulances Arkansas Child Child, Preschool Equipment Design Extracorporeal Membrane Oxygenation* / adverse effects, instrumentation, mortality Female Heart Diseases / mortality, physiopathology, therapy* Heart Transplantation Hemodynamics* Hospital Mortality Hospitals, Pediatric Humans Infant Infant, Newborn Logistic Models Male Odds Ratio Patient Discharge Patient Transfer* Renal Dialysis / adverse effects, mortality Retrospective Studies Risk Assessment Risk Factors Time Factors Transportation of Patients* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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