Related Experiment Video
Updated: Jun 16, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Post cardiotomy extracorporeal membrane oxygenation in pediatric patients: Results and neurodevelopmental outcomes
Alessandro Varrica1, Mauro Cotza1, Mauro Lo Rito1
1Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
Insights
High lactate and bilirubin levels increase mortality risk in pediatric ECMO patients. Extracorporeal cardiopulmonary resuscitation (ECPR) is a key factor for brain injury, but neurodevelopmental outcomes improve over time.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Congenital cardiac surgery complexity necessitates increased use of extracorporeal membrane oxygenation (ECMO) in pediatric patients.
- Identifying mortality and brain injury risk factors in post-cardiotomy ECMO is crucial for improving outcomes.
Purpose of the Study:
- To identify risk factors for mortality and brain injury in pediatric patients undergoing post-cardiotomy ECMO.
- To evaluate the neurological outcomes and neurodevelopmental status of these patients.
Main Methods:
- Retrospective analysis of pediatric patients with congenital heart disease requiring post-cardiotomy ECMO.
- Assessment of risk factors for in-hospital mortality and brain injury.
- Neurodevelopmental assessment using the Pediatric Cerebral Performance Category (PCPC) Scale.
Main Results:
- Out of 2651 pediatric patients, 90 required ECMO post-cardiac surgery.
- Pre-implant lactate and peak bilirubin levels were associated with in-hospital mortality.
- Extracorporeal cardiopulmonary resuscitation (ECPR) was a significant risk factor for brain injury (33% incidence).
Conclusions:
- Elevated pre-implant lactate and bilirubin levels are significant risk factors for mortality in pediatric ECMO.
- ECPR is a primary risk factor for brain injury, while CPB weaning failure may be protective.
- Follow-up assessments indicated significant improvements in neurodevelopmental status.
Background:
The increasing complexity of congenital cardiac surgery has led to greater utilization of extracorporeal membrane oxygenation (ECMO) support for children post-surgery. This study aims to identify risk factors for mortality and brain injury in pediatric patients requiring post-cardiotomy ECMO and to evaluate their neurological outcomes.
Methods:
This retrospective study includes pediatric patients with congenital heart diseases who required ECMO after surgery. Risk factors for in-hospital mortality and brain injury were assessed. Neurodevelopmental status was determined using the Pediatric Cerebral Performance Category (PCPC) Scale at discharge and during follow-up.
Results:
Between October 2014 and May 2021, 2651 pediatric patients underwent cardiac surgery, with 90 (3.4%) requiring ECMO. The mean age was 0.6 years, ranging from 1 day to 13 years and 7 months. ECMO was implemented for 45 patients due to CPB weaning failure (NW-CPB), 24 due to postoperative low-cardiac output syndrome (LCOS), and 21 for extracorporeal cardiopulmonary resuscitation (E-CPR). ECMO weaning was achieved in 73 patients (81%), with an overall mortality rate of 36%. Pre-implant lactate levels (OR: 1.13, 95% CI: 1.03-1.25; p = 0.009) and peak bilirubin levels (OR: 1.04, 95% CI: 0.87-1.24; p = 0.69) were risk factors for in-hospital mortality. Survival rates were 79% for LCOS, 60% for NW-CPB, and 48% for E-CPR. Brain injury incidence was 33%, with E-CPR being a significant risk factor (p = 0.006) and NW-CPB being protective (p = 0.001). Follow-up in November 2023 showed significant improvement in neurodevelopmental status (p < 0.001).
Conclusion:
Elevated pre-implant lactate and elevated bilirubin levels during ECMO are major risk factors for mortality. E-CPR is the primary risk factor for brain injury. Follow-up revealed significant improvements in neurodevelopmental outcomes.
