Abstract Background Hypoxic hepatitis (HH) is highly prevalent during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support and is strongly associated with adverse outcomes. However, the incidence, risk factors, and prognostic impact of HH in pediatric patients receiving VA-ECMO after cardiac surgery remain inadequately explored. This study aims to investigate the incidence of HH, identify associated risk factors, and evaluate its effect on clinical outcomes in this patient population. Methods This single-center retrospective study included pediatric patients who underwent VA-ECMO support following cardiac surgery. Preoperative, intraoperative, and postoperative variables were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for HH. Additionally, Kaplan-Meier (KM) survival analysis was conducted to compare 30-day and 180-day survival rates between the HH and non-HH groups, with survival curves analyzed using the log-rank test. Results A total of 96 pediatric patients receiving VA-ECMO were included, with an HH incidence of 26%. Multivariate logistic regression analysis identified elevated white blood cell (WBC) count within 24 hours post-ECMO initiation (OR = 1.258, 95% CI: 1.083–1.502, p = 0.005) and higher peak ECMO pump flow (OR = 1.030, 95% CI: 1.010–1.054, p = 0.006) as independent risk factors for HH. Compared to non-HH patients, those with HH had significantly shorter ICU stays (14.00 8.00, 31.00 vs. 30.00 17.00, 48.00, p = 0.031), lower ECMO weaning success rates (44.0% vs. 80.0%, p = 0.002), and higher incidence of acute kidney injury (AKI) (Stage 3 AKI: 96.0% vs. 57.7%, p = 0.005). Moreover, HH was associated with significantly increased 30-day mortality (64.0% vs. 28.2%, p = 0.003) and 180-day mortality (76.0% vs. 43.7%, p = 0.011). Kaplan-Meier survival analysis demonstrated significantly lower 30-day and 180-day survival rates in the HH group compared to the non-HH group (log-rank p 0.05), reinforcing the strong association between HH and poor prognosis. Conclusion This study identifies elevated WBC count within 24 hours post-ECMO initiation and higher peak ECMO pump flow as independent risk factors for HH in pediatric VA-ECMO patients. HH is associated with significantly worse outcomes, including lower weaning success, higher AKI rates, and increased mortality. Survival analysis confirms the strong correlation between HH and poor prognosis. Future research should focus on optimizing ECMO management to reduce HH incidence and improve long-term survival in pediatric patients.
Liu et al. (Sat,) studied this question.