ECMO in adults with congenital heart disease - Analysis of a national discharge database

Background: The number of adults with congenital heart disease (CHD) is increasing and long-term complications may lead to a need for extracorporeal membrane oxygenation (ECMO), but there are no large studies describing outcomes. We sought to describe the epidemiology for adult CHD patients who undergo ECMO and compare outcomes to adults without CHD (NO-CHD) requiring ECMO. Methods: Query of hospital discharge data from Vizient from October 2014–December 2017 for patients ≥18 years old with an ICD-9 or ICD-10 code for CHD (745–747.49, Q20.0 – Q26.4) and a procedure code for ECMO (39.65 or 5A15223). Demographics, diagnosis, length of stay (LOS), complications and in-hospital mortality were collected and compared. Results: There were 61,136 adult CHD admissions, 440 (0.7%) with ECMO, compared to 16,122,820 NO-CHD admissions, 11,905 (0.07%) with ECMO (p < 0.001). Adults with CHD were younger (49.2 ± 17 vs 52.5 ± 17.8 years, p < 0.001), had a longer LOS (33.7 ± 45.9 vs 29.4 ± 37.1 days, p = 0.020) and more complications (54% vs 40%, p < 0.001). Conclusions: Adults with CHD who require ECMO have longer hospitalizations and more complications than adults without CHD who require ECMO. ECMO for adults with CHD appears related to surgical admissions, compared to ECMO for adults without CHD, which appears related to acquired diseases. These data highlight the implications of ECMO for adults with CHD and their potential perioperative fragility.