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Open in new tab Download slide OBJECTIVES The aim of this study was to assess the early outcomes and risk factors of paediatric patients requiring extracorporeal membrane oxygenation after cardiac surgery (post-cardiotomy). METHODS Retrospective binational cohort study from the Australia and New Zealand Congenital Outcomes Registry for Surgery database. All patients younger than 18 years of age who underwent a paediatric cardiac surgical procedure from 1 January 2013 to 31 December 2021 and required post-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) in the same hospital admission were included in the study. RESULTS Of the 12 290 patients included in the study, 376 patients required post-cardiotomy ECMO (3%). Amongst these patients, hospital mortality was 35.6% and two-thirds of patients experienced a major complication. Hypoplastic left heart syndrome was the most common diagnosis (17%). The Norwood procedure and modified Blalock–Taussig shunts had the highest incidence of requiring PC-ECMO (odds ratio of 10 and 6.8 respectively). Predictors of hospital mortality after PC-ECMO included single-ventricle physiology, intracranial haemorrhage and chylothorax. CONCLUSIONS In the current era, one-third of patients who required PC-ECMO after paediatric cardiac surgery in Australia and New Zealand did not survive to hospital discharge. The Norwood procedure and isolated modified Blalock–Taussig shunt had the highest incidence of requiring PC-ECMO. Patients undergoing the Norwood procedure had the highest mortality (48%). Two-thirds of patients on PC-ECMO developed a major complication. [ABSTRACT FROM AUTHOR]

Objectives: To describe longer-term survival and morbidity outcomes after hospital discharge in a binational cohort of children who required extracorporeal membrane oxygenation after cardiac surgery., Methods: Retrospective cohort study from the Australia and New Zealand Congenital Outcomes Registry for Surgery database. All patients younger than 18 years of age (n=12,290) undergoing paediatric cardiac surgical procedures between 1 January 2013 and 31 December 2021 who required post-cardiotomy extracorporeal membrane oxygenation in the same admission were included., Results: Among 376 (3%) patients who required post-cardiotomy extracorporeal membrane oxygenation, 242 (64.4%) survived to hospital discharge. Median follow-up in survivors post-hospital discharge was 4.2 years (IQR 2.6 - 8 years). Kaplan-Meier survival at 1, 3, 5 and 8 years was 62%, 58.5%, 55.8%, and 52.6%. Post-discharge survival was 95.5%, 90.7%%, 87.1% and 81.9% at 1, 3, 5, and 8 years respectively. Survival was significantly poorer in patients with single ventricle physiology. 43.3% (n=105) of hospital survivors had at least one major morbidity at the last follow-up. The most common major morbidities were developmental delay, permanent neurological deficits, and growth restriction., Conclusions: 38% of children who required ECMO after cardiac surgery did not survive beyond 1 year. However, of patients who survived to hospital discharge, 95% were alive at one year. Approximately 80% of patients were alive at 5 years after hospital discharge. Outcomes were poorer in patients with single ventricle physiology. 40% of patients had significant morbidity after hospital discharge., (Copyright © 2024. Published by Elsevier Inc.)