What question did this study set out to answer?

To compare outcomes of neonates with d-TGA receiving ECMO support before arterial switch operation.

January 6, 2026Pediatric Critical Care Medicine0 citations

Preoperative Extracorporeal Membrane Oxygenation in Children With Dextro-Transposition of the Great Arteries: Extracorporeal Life Support Organization Registry Study, 2000–2022

LKLena KoersLeiden University Medical Center RTRavi R. ThiagarajanPediatric Cardiology RPRoel L. F. van der Palen

Key Points

To compare outcomes of neonates with d-TGA receiving ECMO support before arterial switch operation.
Retrospective analysis of ELSO Registry data (2000–2022)
Included neonates aged up to 21 days with d-TGA supported by ECMO before ASO
Measured mortality rates and complications related to ECMO and ASO.
Overall mortality was 33% among neonates supported with preoperative ECMO.
Mortality associated with ECMO support was higher compared to those weaned before ASO.
72% of neonates on ECMO experienced complications, higher than those weaned from ECMO before surgery.

Abstract

Objective: To describe those neonates with dextro-transposition of the great arteries (d-TGA) who undergo preoperative support with extracorporeal membrane oxygenation (ECMO) and to compare outcomes in those undergoing the arterial switch operation (ASO) on-ECMO vs. those who undergo ASO after weaning from ECMO. Design: Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) Registry data, 2000–2022. Patients: Neonates aged up to 21 days with d-TGA supported by ECMO before ASO. Interventions: None. Measurements and Main Results: We identified 100 neonates with a median (interquartile range IQR) age at ECMO initiation of 4 days (IQR 1–9) and median weight of 3.4 kg (IQR 3–3.7). Mortality, as opposed to survival, was associated with the following: older age at ECMO initiation (7 d IQR 2–12 vs. 2 d IQR 1–6, p = 0.01), lower birthweight (3.2 kg IQR 2.8–3.7 vs. 3.5 kg IQR 3.1–3.7, p = 0.04), longer aortic clamp time (129 min IQR 94–191 vs. 98 min IQR 72–121, p = 0.02), longer cardiopulmonary bypass time (326 min IQR 217–415 vs. 174 min IQR 137–241, p < 0.001), and longer duration of ECMO support (7 d IQR 4–11 vs. 4 d IQR 2–5, p < 0.001). Also, mortality, compared with survival, was associated with occurrence of any complication and the need for renal replacement therapy (both p < 0.001). Overall, 64 of 91 (70%) neonates supported with preoperative ECMO underwent ASO on ECMO. In comparison with those undergoing ASO after ECMO, these patients had more complications (53/64 83% vs. 16/27, p = 0.02) and had higher mortality than those weaned from ECMO preoperatively (24/64 38% vs. 4/27, p = 0.03). Conclusions: In the ELSO 2000–2022 cohort of neonates with d-TGA, supported with preoperative ECMO, overall mortality was 33%. Continued postoperative ECMO support was associated with worse mortality. Therefore, we wonder whether successful weaning from ECMO before ASO may be associated with improved outcomes.

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Cite This Study

Koers et al. (Mon,) studied this question.

synapsesocial.com/papers/695d85373483e917927a4227 https://doi.org/https://doi.org/10.1097/pcc.0000000000003893

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