Related Experiment Video
Updated: Aug 15, 2026
09:54
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Extracorporeal Membrane Oxygenation in Children after Fontan Operation
Pilar Anton-Martin1, Rodrigo Cardoso Cavalcante1, Lindsay Master2
1Department of Pediatrics, Division of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
The Journal of Thoracic and Cardiovascular Surgery
|August 13, 2026
Summary
Survival after extracorporeal membrane oxygenation (ECMO) for pediatric Fontan patients has improved. Avoiding pre-ECMO arrest and enabling earlier cannulation may enhance outcomes for these complex cases.
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.
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure used in critically ill patients.
- Outcomes for pediatric patients requiring ECMO post-Fontan palliation are not well-defined.
Purpose of the Study:
- To investigate the outcomes of pediatric patients who require ECMO following the Fontan operation.
- To identify factors associated with survival in this high-risk population.
Main Methods:
- Retrospective cohort analysis of the Extracorporeal Life Support Organization (ELSO) registry.
- Inclusion criteria: patients <18 years old undergoing ECMO after Fontan palliation between 2010-2023 during their surgical hospitalization.
- Data collected included patient demographics, ECMO characteristics, and clinical outcomes.
Main Results:
- Survival to hospital discharge was 48.4% among 281 children.
- Veno-arterial ECMO was the predominant support strategy (92%).
- Independent predictors of mortality included pre-ECMO arrest, bicarbonate administration, higher ECMO flow, longer ECMO duration, delayed cannulation, and neurologic, renal, or pulmonary complications.
Conclusions:
- Hospital survival after ECMO post-Fontan palliation shows improvement compared to historical data.
- Avoiding pre-ECMO arrest and achieving earlier cannulation are potentially modifiable factors to improve outcomes.
- Further prospective studies are needed to optimize timing and support strategies for this patient group.
