Circuit Change, Peri-Change Anticoagulation and Transfusion, and Survival in Pediatric Postcardiotomy Extracorporeal...

Circuit and oxygenator changes during pediatric postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) are clinically significant; however, their timing and management are poorly described. Moreover, outcomes beyond discharge remain unclear. We describe circuit changes, temporal trends in anticoagulant use and transfusion, and mid- to long-term survival in pediatric PC-ECMO. This study used a Japanese administrative database spanning 2014-2024. Cardiac surgery cases in patients aged <18 years with congenital heart disease were classified into PC-ECMO and non-ECMO groups. For the PC-ECMO group, we assessed the cumulative incidence of the first circuit change, temporal trends in anticoagulant use and transfusion around each change, and postoperative and post-discharge 1 year survival. Among 4,395 cases, 73 involved PC-ECMO. Of these, 24 (32.9%) required at least one circuit change, with a cumulative incidence of 33.1% (95% confidence interval [CI], 19.4-46.7) within 3 days. Anticoagulants were switched from heparin to nafamostat mesylate alone or no anticoagulation (p = 0.001), and fresh-frozen plasma transfusion increased on the day of change (p = 0.016). Postoperative 1 year survival was 0.566 (95% CI, 0.449-0.713); among those discharged alive, 1 year post-discharge survival was 0.967 (95% CI, 0.901-1.000). Circuit changes were common and occurred early after PC-ECMO initiation. Post-discharge survival was favorable among patients discharged alive.