Abstract
Objectives: To determine whether mortality differs between roller and centrifugal pumps used during extracorporeal membrane oxygenation in infants weighing less than 10 kg. Design: Retrospective propensity-matched cohort study. Setting: All extracorporeal membrane oxygenation centers reporting to the Extracorporeal Life Support Organization. Patients: All patients less than 10 kg supported on extracorporeal membrane oxygenation during 2011-2016 within Extracorporeal Life Support Organization Registry. Interventions: Centrifugal and roller pump recipients were propensity matched (1:1) based on predicted probability of receiving a centrifugal pump using demographic variables, indication for extracorporeal membrane oxygenation, central versus peripheral cannulation, and pre-extracorporeal membrane oxygenation patient management. Measurements and Main Results: A total of 12,890 patients less than 10 kg were supported with extracorporeal membrane oxygenation within the Extracorporeal Life Support Organization registry during 2011-2016. Patients were propensity matched into a cohort of 8,366. Venoarterial and venovenous extracorporeal membrane oxygenation runs were propensity matched separately. The propensity-matched cohorts were similar except earlier year of extracorporeal membrane oxygenation (standardized mean difference, 0.49) in the roller pump group. Within the propensity-matched cohort, survival to discharge was lower in the centrifugal pump group (57% vs 59%; odds ratio, 0.91; 95% CI, 0.83-0.99; p = 0.04). Hemolytic, infectious, limb injury, mechanical, metabolic, neurologic, pulmonary, and renal complications were more frequent in the centrifugal pump group. Hemorrhagic complications were similar between groups. Hemolysis mediated the relationship between centrifugal pumps and mortality (indirect effect, 0.023; p < 0.001). Conclusions: In this propensity score-matched cohort study of 8,366 extracorporeal membrane oxygenation recipients weighing less than 10 kg, those supported with centrifugal pumps had increased mortality and extracorporeal membrane oxygenation complications. Hemolysis was evaluated as a potential mediator of the relationship between centrifugal pump use and mortality and met criteria for full mediation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1177-1184 |
| Number of pages | 8 |
| Journal | Pediatric Critical Care Medicine |
| Volume | 20 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2019 |
Funding
1Department of Pediatrics, Boston Children’s Hospital, Boston, MA. 2Department of Cardiology, Boston Children’s Hospital, Boston, MA. 3Department of Pediatrics, Harvard Medical School, Boston, MA. 4Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA. 5Divisions of Pediatric Critical Care and Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI. 6Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA. 7Extracorporeal Life Support Organization, Ann Arbor, MI. 8Pediatrics-Critical Care, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal). Supported, in part, by the Rochelle E. Rose Cardiac Intensive Care Unit Research Funds. Dr. Thiagarajan’s institution received funding form Pfizer and Bristol Myers Squibb. Dr. Barbaro disclosed that he is the Extracorporeal Life Support Organization Registry Chair, and he received support for article research from National Institutes of Health and K12 HL138039 Training to Advance Care Through Implementation science in Cardiac And Lung illnesses. Mr. Alexander’s institution received funding from Tenax Therapeutics (supplied levosimendan for an expanded access protocol clinical trial) and Novartis, and he disclosed off-label product use of extracorporeal membrane oxygenation. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: cohalloran@luriechildrens. org Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Keywords
- children
- complications
- extracorporeal membrane oxygenation
- hemolysis
- pump
- survival
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Pediatrics, Perinatology, and Child Health