Clinical outcomes after tracheostomy in children with single ventricle physiology: Collaborative research from the Pediatric Cardiac Intensive Care Society Multicenter Cohort, 2010-2021

Christopher W. Mastropietro, Department of Pediatrics, Division of Critical Care Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.
Peter Sassalos, Department of Cardiac Surgery, C.S. Mott Children's Hospital, Ann Arbor, MI.
Christine M. Riley, Department of Pediatrics, Division of Cardiac Critical Care, Children's National Health System, Washington, DC.
Kurt Piggott, Department of Pediatrics, Division of Pediatric Cardiac Critical Care LSU School of Medicine Children's Hospital, New Orleans, LA.
Kiona Y. Allen, Department of Pediatrics, Division of Cardiac Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
Elizabeth Prentice, Department of Pediatrics, Division of Critical Care, Helen Devos Children's Hospital, Grand Rapids, MI.
Raya Safa, Department of Pediatrics, Division of Critical Care, Children's Hospital of Michigan, Detroit, MI.
Jason R. Buckley, Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC.
David K. Werho, Department of Pediatrics, Division of Pediatric Cardiology, University of California San Diego, Rady Children's Hospital, San Diego, CA.
Martin Wakeham, Department of Pediatrics, Division of Cardiac Critical Care, Medical College of Wisconsin, Herma Heart Institute-Children's Wisconsin, Milwaukee, WI.
Arthur Smerling, Department of Pediatrics, Division of Critical Care, Columbia University Irving Medical Center, New York, NY.
Andrew R. Yates, Department of Pediatrics, Sections of Cardiology and Critical Care, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
Ilias Iliopoulos, Department of Pediatrics, Division of Cardiac Critical Care, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Hitesh Sandhu, Department of Pediatrics, Division of Pediatric Critical Care, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN.
Saurabh Chiwane, Department of Pediatrics, Division of Pediatric Critical Care, Saint Louis University, Cardinal Glennon Children's Hospital, Saint Louis, MO.
Asaad Beshish, Department of Pediatrics, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, GA.
David M. Kwiatkowski, Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, CA.
Saul Flores, Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
Sukumar Suguna Narashimhulu, Department of Pediatrics, Division of Cardiology, Arnold Palmer Children's Hospital, Orlando, FL.
Rohit Loomba, Advocate Health - MidwestFollow
Christine A. Capone, Department of Pediatrics, Division of Pediatric Critical Care, Cohen Children's Medical Center, New Hyde Park, NY.
Francis Pike, Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN.
John M. Costello, Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC.

Affiliations

Advocate Children's Hospital

Abstract

Objectives: Multicenter studies reporting outcomes following tracheostomy in children with congenital heart disease are limited, particularly in patients with single ventricle physiology. We aimed to describe clinical characteristics and outcomes in a multicenter cohort of patients with single ventricle physiology who underwent tracheostomy before Fontan operation.

Design: Multicenter retrospective cohort study.SETTING: Twenty-one tertiary care pediatric institutions participating in the Collaborative Research from the Pediatric Cardiac Intensive Care Society.

Patients: We reviewed 99 children with single ventricle physiology who underwent tracheostomy before the Fontan operation at 21 institutions participating in Collaborative Research from the Pediatric Cardiac Intensive Care Society between January 2010 and December 2020, with follow-up through December 31, 2021.

Interventions: None.

Measurements and main results: Death occurred in 51 of 99 patients (52%). Cox proportional hazard analysis was performed to determine factors associated with death after tracheostomy. Results are presented as hazard ratio (HR) with 95% CIs. Nonrespiratory indication(s) for tracheostomy (HR, 2.21; 95% CI, 1.14-4.32) and number of weeks receiving mechanical ventilation before tracheostomy (HR, 1.06; 95% CI, 1.02-1.11) were independently associated with greater hazard of death. In contrast, diagnosis of tricuspid atresia or Ebstein's anomaly was associated with less hazard of death (HR, 0.16; 95% CI, 0.04-0.69). Favorable outcome, defined as survival to Fontan operation or decannulation while awaiting Fontan operation with viable cardiopulmonary physiology, occurred in 29 of 99 patients (29%). Median duration of mechanical ventilation before tracheostomy was shorter in patients who survived to favorable outcome (6.1 vs. 12.1 wk; p < 0.001), and only one of 16 patients with neurologic indications for tracheostomy and 0 of ten patients with cardiac indications for tracheostomy survived to favorable outcome.

Conclusions: For children with single ventricle physiology who undergo tracheostomy, mortality risk is high and should be carefully considered when discussing tracheostomy as an option for these children. Favorable outcomes are possible, although thoughtful attention to patient selection and tracheostomy timing are likely necessary to achieve this goal.

Type

Article

PubMed ID

38683049

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