Extracorporeal membrane oxygenation support after the Fontan operation

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• The Fontan operation is a palliative procedure for complex single-ventricle congenital heart disease.
• Post-Fontan cardiac failure can necessitate mechanical circulatory support, such as extracorporeal membrane oxygenation (ECMO).
• High mortality rates and unclear causes of death in these patients highlight the need for further investigation.

Purpose of the Study:

• To evaluate in-hospital mortality rates in pediatric patients requiring ECMO after the Fontan operation.
• To identify factors associated with increased mortality in this high-risk population.

Main Methods:

• Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) registry data (1987-2009).
• Inclusion of pediatric patients who underwent ECMO post-Fontan operation.
• Comparison of demographics and ECMO data between survivors and nonsurvivors, utilizing multivariable logistic regression to identify mortality predictors.

Main Results:

• Of 230 patients, 35% survived to hospital discharge.
• Nonsurvivors showed higher rates of pre-ECMO cardiopulmonary resuscitation and higher fraction of inspired oxygen.
• Neurologic injury (OR 5.18), surgical bleeding (OR 2.36), and renal failure (OR 2.81) significantly increased mortality.
• ECMO duration between 65-119 hours was associated with decreased mortality (OR 0.33).

Conclusions:

• Cardiac failure requiring ECMO post-Fontan operation is associated with substantial in-hospital mortality.
• Complications during ECMO support, including neurologic injury, surgical bleeding, and renal failure, are significant contributors to mortality.
• Timely surgical intervention for bleeding may improve survival outcomes in these critically ill children.