Outcomes in Children Who Undergo Postcardiotomy Extracorporeal Membrane Oxygenation: A Report From the STS-CHSD.

Background: Children who undergo cardiac surgery may require postcardiotomy extracorporeal membrane oxygenation (ECMO). Although morbidities are considerable, our understanding of outcome determinants is limited. We evaluated associations between patient and perioperative factors with outcomes.
Methods: The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried for patients aged <18 years old who underwent postcardiotomy ECMO from January 2016 through June 2021. The primary outcome was survival to hospital discharge. The secondary outcome was survival without neurologic injury. Logistic regression for binary outcomes and competing risk analysis for survival were used to identify the most important predictors. Variables were selected by stepwise procedure using entry level P = .35. Those with P ≤ .1 were kept in the final model.
Results: Postcardiotomy ECMO was used to support 3181 patients during the same hospitalization as cardiac surgery: (A) intraoperative initiation of ECMO, n = 1206; (B) early postoperative (≤48 hours), n = 936; and (C) late postoperative (>48 hours), n = 1039. The most common primary procedure of the index operation was the Norwood procedure. Of those with intraoperative ECMO, 57% survived to discharge vs 59% with early postoperative ECMO and 42% late postoperative ECMO (χ ² ₍₂₎  = 64, P < .0001, V = 0.14). In all groups, postoperative septicemia, cardiac arrest, and new neurologic injury had the strongest association with mortality, whereas postoperative reintubation and unplanned noncardiac reoperation were associated with higher survival.
Conclusions: Multiple risk factors impact survival in children who undergo cardiac surgery and postcardiotomy ECMO. ECMO initiated >48 hours after surgery is associated with the poorest outcomes. This is the first step in creating a predictive tool to educate clinicians and families regarding expectations in this high-risk population.
Competing Interests: Disclosures Farhan Zafar reports a relationship with TransMedics Inc that includes: employment. David S. Cooper reports a relationship with Mallinckrodt LLC that includes: consulting or advisory and with Prolacta Bioscience Inc that includes: speaking and lecture fees. Ravi Thiagarajan reports a relationship with Extracorporeal Life Support Organization that includes: speaking and lecture fees and with the Society of Critical Care Medicine that includes: speaking and lecture fees. Jeffrey P. Jacobs reports a relationship with American Academy of Dermatology that includes: consulting or advisory and with SpecialtyCare that includes: consulting or advisory. Iki Adachi reports a relationship with Nipro Corporation that includes: speaking and lecture fees. Katsuhide Maeda reports a relationship with Abbott that includes: consulting or advisory and with Peca Labs that includes: consulting or advisory. David L.S. Morales reports a relationship with Abbott that includes: consulting or advisory; with Peca Labs that includes: consulting or advisory; with Berlin Heart that includes: consulting or advisory; and with SynCardia Systems LLC that includes: consulting or advisory. The other authors have no conflicts of interest to disclose.
(Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)