Extracorporeal Membrane Oxygenation in Anomalous Left Coronary Artery from the Pulmonary Artery

Patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) occasionally require perioperative extracorporeal membrane oxygenation support (ECMO). Outcomes and associations with survival in this cohort are poorly described. This study utilized an international database to identify the associations with mortality and cardiac non-recovery in children with ALCAPA receiving perioperative ECMO. Retrospective analysis was performed using the Extracorporeal Life Support Organization registry database for patients with ALCAPA undergoing ECMO cannulation between 2005 and 2022. Demographic information, clinical characteristics, and ECMO-related variables and complications were compared. Of 163 patients with ALCAPA analyzed, overall survival to discharge was 74%. Non-survivors had lower weight and suffered more complications on ECMO compared with survivors. In multivariable analysis, time to ECMO (OR 1.03, 95% CI 1.01-1.05), pre-ECMO pH (OR 0.02, 95% CI 0.01-0.67), length of ECMO run (OR 1.01, 95% CI 1.00-1.01), and presence of mechanical (OR 6.33, 95% CI 1.81-22.1) and neurologic complications (OR 7.6, 95% CI 2.1-27.9) had increased odds for poor outcome. Factors associated with mortality and cardiac non-recovery for patients with ALCAPA on ECMO include pre-ECMO variables and accrued complications on ECMO. Thoughtful consideration of timing of ECMO deployment and careful ECMO management to prevent complications are necessary to improve outcomes in this population.