562 - ECMO utilization and staged palliation in single ventricle patients in the United States: Mortality insights from the 2022 KID Database

Publication Number: 1540.562

Joseph P. Dario, The Mount Sinai Kravis Children's Hospital, New York, NY, United States; Thinh T.. Vu, CUNY School of Public Health, New York, NY, United States; Sandeep Tripathi, University of Illinois College of Medicine, edwards, IL, United States; Rachel Moss, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Shubhi Kaushik, Icahn School of Medicine at Mount Sinai, NY, NY, United States

Background: Single ventricle (SV) patients represent some of the most vulnerable groups with congenital cardiac disease, with high in-hospital mortality. Extracorporeal Membrane Oxygenation (ECMO) is frequently utilized as rescue both pre-operatively and post-operatively in SV patients across all stages of their palliative surgery. There is limited population-based data on ECMO utilization and its association with mortality among SV patients undergoing staged palliation rescued with ECMO.

Objective: To describe the mortality and its associations with ECMO utilization and staged palliation among SV patients.

Design/Methods: We utilized data from the Healthcare Cost and Utilization Project 2022 Kids Inpatient Database (KID), the largest and latest publicly available pediatric database in the United States. Only patients with classic SV ICD-10 diagnosis codes were included. Information on ECMO (all patients) and staged palliation procedure codes for Stage I and Glenn (patients < 1y), and Fontan (patients ≥1y) procedures were extracted. We calculated weighted prevalence of ECMO, stage of palliation, and mortality. Multiple logistic regression models assessed associations between mortality, ECMO, and stage of palliation.

Results: Of the 7,238 patients included, the mean age was 3.1 years old, with 57.7% male and 48.7% white. The prevalence of ECMO exposure was 3.3%. The proportions of patients who underwent Stage I palliation, Glenn, and Fontan palliation were 17.0%, 15.6%, and 16.4%, respectively. Mortality was significantly higher in SV patients who received ECMO compared to those who did not (46.5% vs. 3.9%, p< 0.001). This trend was consistent across all stages of palliation: ECMO with Stage I repair (42.2% vs. 5.1%, p< 0.001), ECMO with Glenn (37.8% vs. 0.7%, p< 0.001), and ECMO with Fontan (57.1% vs. 0%, p< 0.001), compared to those who did not require ECMO with the respective palliative procedure. Adjusted models showed that ECMO use was associated with higher mortality overall, while Stage I and Glenn procedures were linked to lower mortality compared to admissions without surgical intervention. No significant association was found between mortality and race, sex, household income quartile, or hospital region, while elective admission was associated with lower mortality.

Conclusion(s): ECMO remains associated with high mortality in the SV population, highlighting the complex and high-risk nature of managing these patients. Our study emphasizes the need for further research in optimizing patient selection, ECMO timing, and peri-operative care to improve outcomes in SV patients who require rescue with ECMO.