A Novel Approach to Delivery of Extracorporeal Support Using a Modified Continuous Flow Ventricular Assist Device in a Mid-Volume Congenital Heart Program
Harma K. Turbendian1, Jeremy Gebhardt2, Peter Scherkenbach2, Matthew J. Zawadzki3, Michael Shillingford1
1UPMC Wolfson Children's Hospital, Jacksonville, FL, USA, 2Baptist Medical Center - Wolfson Children's Hospital, Jacksonville, FL, USA, 3School of Social Science, Humanities, and Arts, University of California - Merced, Merced, CA, USA
OBJECTIVE: Extracorporeal life support (ECLS) is an essential component of a modern congenital cardiac surgery program. Here we evaluate our initial experience with a modified ventricular assist device - based ECLS circuit primarily managed by the bedside nurse. We hypothesize that our outcomes are noninferior to Extracorporeal Life Support Organization (ELSO) registry data.
METHODS: All patients who received ECLS from January 1, 2016 through December 31, 2019 at a single institution were included. Primary outcomes were survival to ECLS decannulation and discharge or transfer. Secondary outcomes included complications from ECLS. Data was compared to available ELSO registry data.
RESULTS: Thirty-seven patients underwent 44 ECLS runs during the study period. Forty percent of patients had single ventricle physiology. Nearly 46% of patients received ECLS as part of extracorporeal cardiopulmonary resuscitation (eCPR). Survival to ECLS decannulation (68.2%) and survival to discharge or transfer (61.4%) were noninferior to overall ELSO outcomes (69.7%, P = .870 and 50.7%, P = .136), as well as survival to discharge or transfer in a comparable cohort of ELSO centers (53.1%, P = .081). Neurologic (50.0%), hemorrhagic (45.5%), and renal complications (31.8%) were most common in this cohort.
CONCLUSIONS: A modified ventricular assist device-based ECLS circuit with primary management by the bedside nurse can provide comparable support in a neonatal and pediatric cardiac surgery population. Cost analyses and further delineation of the complication profile are necessary for a complete characterization of this system.
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