Outcomes after hospital discharge in children requiring post-cardiotomy extracorporeal membrane oxygenation: A binational retrospective cohort study

Abstract

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: This was a 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 pediatric cardiac surgical procedures between January 1, 2013, and December 31, 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 posthospital discharge was 4.2 years (interquartile range, 2.6-8 years). Kaplan-Meier survival at 1, 3, 5, and 8 years was 62%, 58.5%, 55.8%, and 52.6%. Postdischarge 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. In total, 43.3% (n = 105) of hospital survivors had at least 1 major morbidity at the last follow-up. The most common major morbidities were developmental delay, permanent neurologic deficits, and growth restriction.

Conclusions: In total, 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 1 year. Approximately 80% of patients were alive at 5 years after hospital discharge. Outcomes were poorer in patients with single-ventricle physiology. In total, 40% of patients had significant morbidity after hospital discharge.

Keywords: congenital cardiac surgery; extracorporeal membrane oxygenation; morbidity; mortality; pediatric.