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

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Pediatric Critical Care Medicine


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.

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