Extracorporeal Life Support Registry Report 2008: Neonatal and Pediatric Cardiac Cases NIKKOLE M. HAINES,* PETER T. RYCUS,† JOSEPH B. ZWISCHENBERGER,‡ ROBERT H. BARTLETT,† AND AKIF ¨ UNDAR*§ Each year thousands of patients require extracorporeal life sup- port (ECLS) for a variety of respiratory, cardiac, and emergency reasons. The ECLS registry, a Federal Drug Administration ap- proved control group, provides a database of approximately 37,000 ECLS patients from domestic and international hospitals, with details about demographic factors, diagnosis, treatment, and complications. The report is circulated to Extracorporeal Life Support Organization members with the goal of providing feedback on each center’s practices relative to the performance of all of the centers, and to the general public with the goal of enhancing research and improving patient care. In this report, the ECLS Registry Report International Summary for July 2008 is analyzed with a specific focus on neonatal and pediatric cardiac patients. From the data, it is evident that cardiac ECLS patients have a lower chance of survival than respiratory ECLS patients, and furthermore, younger patients have a lower chance of sur- vival. Requirement for inotropes while on ECLS is by far the most common complication, followed by surgical site bleeding, ne- cessitating hemofiltration. The major mechanical complications facing cardiac ECLS patients are oxygenator failure and clots in the circuit. Databases such as this one provide powerful tools for institutions, clinicians, and researchers. ASAIO Journal 2009; 55:111–116. T he Extracorporeal Life Support Organization (ELSO) serves to enhance the care of patients receiving extracorporeal life support (ECLS). ELSO provides quality assurance testing for ECLS centers, scientist’s large amounts of data from each ECLS patient, which furnishes treatment guidelines, training sessions for professionals and laymen, and enhances communication between ECLS centers. 1,2 Each ECLS patient is registered into the database and classified based on age and etiologic reason for ECLS implementation to make three groups within each age group: respiratory, cardiac, and extracorporeal cardiopulmo- nary resuscitation. The registry report presents data on overall patient outcomes, number of cases, patient diagnoses, surgery types, procedure types, support modes, and complications. In terms of clinical research, the ECLS registry is a Federal Drug Administration approved control group and the large sample size of this database provides immense statistical power. As of July 2008, 115 active centers comprised the ELSO membership and 37,717 patient cases have been recorded in the registry from over 170 centers within and outside of the United States. 3 The neonatal (31 days of age) and pediatric (under 18 years of age) age groups totaled 35,030 registered patients as of July 2008. In this article, we will focus predominantly on neonatal and pediatric cardiac cases. Brown and Goldman 4 noted that re- cent years have shown increasing numbers of cardiac ECLS patients and decreasing numbers of respiratory ECLS patients. This could be associated with increased access to ECLS cen- ters, and more complex and diverse uses for ECLS with regard to cardiac cases, and improved conventional and innovative neonatal care with regard to respiratory ECLS cases. 2,4,5 Fur- thermore, as more high-risk patients, especially neonatal pa- tients, are treated with complex surgeries, ECLS durations have the potential to increase because these patients may have poorer cardiac and pulmonic functions after surgery. 5 This article focuses on recent trends in ECLS with regard to survival, duration, support mode, diagnosis, procedures, surgeries, complications, and age. Methods The ELSO registry began collecting information on ECLS patients in 1989. 2 Since then, the database has expanded to include data from 170 institutions, both in United States and abroad, and currently the ELSO has 115 active members. 3 Each active institution provides information on patients with only their birth date and dates of treatment as identifiers. The July 2008 ECLS Registry Report International Summary was analyzed with focus on neonatal and pediatric cardiac ECLS cases. A patient is classified as a cardiac case if cardiac dysfunction is the primary reason for which support is imple- mented. 1 For the purposes of this article, age group 1 includes patients age 0 –30 days, patients age 31 days to less than 1-year are encompassed in age group 2, and patients age 1 year to 16 year are classified in age group 3. Results Overall Outcomes In total, there were 3,416 neonatal cardiac ECLS cases and 4,181 pediatric cardiac cases as of July 2008, numbers much reduced when compared with the cumulative number of re- spiratory ECLS cases in the same age groups. In recent years, the registry report has shown a downward trend in the number of respiratory ECLS cases and an upward trend in the number From the *Department of Pediatrics, Pediatric Cardiac Research Laboratories, Hershey, Pennsylvania; †Extracorporeal Life Support Or- ganization, University of Michigan Medical Center, Ann Arbor, Mich- igan; ‡Department of Surgery, University of Kentucky, Lexington, Kentucky; and §Department of Surgery and Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Hershey Children’s Hospital, Hershey, Pennsylvania. Submitted for consideration September 2008; accepted for publica- tion in revised form September 2008. Reprint Requests: Akif U ¨ ndar, PhD, Penn State College of Medicine, Department of Pediatrics – H085, 500 University Drive, PO Box 850, Hershey, PA 17033-0850. Email: aundar@psu.edu. DOI: 10.1097/MAT.0b013e318190b6f7 ASAIO Journal 2009 111