Early Outcomes of Extracorporeal Membrane Oxygenation in Congenital Heart Surgery

Extracorporeal membrane oxygenation is widely used to treat cardiopulmonary failure after congenital heart surgery. This study evaluated patient characteristics, outcomes, and risk factors associated with perioperative veno-arterial extracorporeal membrane oxygenation use.

All patients undergoing congenital heart surgery between 2001 and 2024 at our centre were included. Prevalence, outcomes, risk factors for extracorporeal membrane oxygenation support, and predictors of in-hospital mortality following extracorporeal membrane oxygenation were analysed.

Among 9892 congenital heart operations, extracorporeal membrane oxygenation was required in 178 (1.8%) patients for a median of 6 days (interquartile range 4-9). Median age and weight at surgery were 2.8 months (interquartile range 0.4-25.2) and 4.1 kg (interquartile range 3.2-8.9), respectively. In patients ≤2 years, the Norwood procedure and surgery for coronary artery malformations were independent risk factors for extracorporeal membrane oxygenation support. Successful weaning was achieved in 62% (n = 111), while 17% (n = 30) required a second extracorporeal membrane oxygenation run. In-hospital mortality after extracorporeal membrane oxygenation was 55% (n = 98), occurring a median of 16 days (interquartile range 5-34) after surgery; 27% of the patients died after a successful first weaning. Model-based predictions showed an 8-fold increase between days 6 and 12 of extracorporeal membrane oxygenation support, with predicted mortality rising from 26% to 74%.

Approximately 2% of patients undergoing congenital heart surgery require extracorporeal membrane oxygenation support with an overall survival rate of around 50%. Prolonged extracorporeal membrane oxygenation duration and acute renal failure requiring renal replacement therapy were independently associated with mortality. The sharp increase in mortality beyond 6 days of extracorporeal membrane oxygenation highlights the need for early reassessment of reversibility and timely consideration of alternative strategies.