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Updated: Jun 11, 2026
Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Clinical Outcomes and Risk Factors in Pediatric Postcardiotomy Extracorporeal Membrane Oxygenation: A Nationwide
Bo Xu1, Xing Zhou1, Xinrui Yu1
1From the Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Post-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) in children has a high in-hospital mortality rate of 48.9%. Key risk factors include complex surgery, prolonged aortic cross-clamp time, and renal complications.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Post-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) is a vital life-saving intervention for pediatric patients experiencing circulatory failure after heart surgery.
- High in-hospital mortality rates persist in this vulnerable population, necessitating identification of associated risk factors.
Purpose of the Study:
- To evaluate the in-hospital mortality rate among pediatric patients undergoing PC-ECMO.
- To identify independent risk factors associated with adverse outcomes in this cohort.
Main Methods:
- Retrospective analysis of 487 pediatric patients (<18 years) who received PC-ECMO from December 2016 to April 2024, utilizing data from the Chinese Society of Extracorporeal Life Support registry.
- Surgical complexity was assessed using the Risk Adjustment in Congenital Heart Surgery-2 (RACHS-2) scoring system.
Main Results:
- The overall in-hospital survival rate was 48.9%, with neonates exhibiting a higher mortality rate (61.4%).
- Independent predictors of mortality included higher RACHS-2 categories (4-5), aortic cross-clamp times exceeding 90 minutes, elevated lactate levels at 24 hours post-PC-ECMO, and the occurrence of renal complications.
- A predictive model incorporating these factors demonstrated good performance (AUC = 0.737).
Conclusions:
- In-hospital mortality following pediatric PC-ECMO remains a significant concern.
- Surgical complexity, duration of aortic cross-clamping, metabolic status (lactate levels), and renal function are critical determinants of survival in pediatric PC-ECMO patients.
Abstract:
Postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) is a critical rescue therapy for pediatric patients with refractory circulatory failure following cardiac surgery. This study aimed to evaluate in-hospital mortality and identify potential risk factors for adverse outcomes in pediatric PC-ECMO patients, using data from the Chinese Society of Extracorporeal Life Support registry. We analyzed pediatric patients (< 18 years) who received PC-ECMO for circulatory support from December 2016 to April 2024. Surgical complexity was categorized using the Risk Adjustment in Congenital Heart Surgery-2 (RACHS-2) method. A total of 487 patients were included, with an overall in-hospital survival rate of 48.9%. Higher mortality was observed in neonates (61.4%) than in infants and children. Independent predictors of in-hospital mortality included RACHS-2 category 4-5 (odds ratio [OR]: 2.976, p < 0.001), aortic cross-clamp time greater than 90 minutes (OR: 1.931, p = 0.007), elevated lactate at 24 hours post-ECMO (OR: 1.221 per mmol/L, p < 0.001), and renal complications (OR: 3.135, p < 0.001). The combined model achieved an area under the curve of 0.737, outperforming the individual predictors. In-hospital mortality in pediatric patients receiving PC-ECMO remains high, and is strongly influenced by surgical complexity, aortic cross-clamp time, metabolic recovery, and renal function.
