Early Outcomes of Extracorporeal Membrane Oxygenation in Congenital Heart Surgery

OBJECTIVES: 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. METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.