Extracorporeal membrane oxygenation in pediatric cardiac surgery: retrospective survival analysis

Extracorporeal membrane oxygenation (ECMO) is a life-saving therapeutic modality in children. Outcome is multifactorial with debates regarding predictors of weaning success and mortality. To explore predictors of ECMO outcome in children with surgically corrected congenital heart disease (CHD). This single-center retrospective cohort study included children with operated CHD who were admitted to a tertiary-care cardiac center in Saudi Arabia during 2022–2025. Demographic data, clinical characteristics, as well as operative and ECMO details were recorded. Predictors of weaning failure and overall mortality during follow-up were analyzed. Thirty children aged 15 days to 12.8 years were included. ECMO connection was applied in day zero in 23 patients (76.6%). ECMO duration ranged between 1 and 15 days. Successful ECMO weaning was achieved in 56.7%. ECMO complication included renal injury in 36.7%, neurological complications in 16.7% and wound infection in 10%. The overall mortality rate was 46.7%. Residual cardiac lesions (OR 20; 95%CI:2.037–196.37 and OR 25.6; 95%CI:2.544-257.566) and ECMO complication (OR 5.4; 95%CI:1.12-26.044 and OR 7.5.6; 95%CI:1.484–37.905) were associated with ECMO failure and mortality during follow-up. Residual cardiac lesions and ECMO-related complications were associated with poor outcome in children with surgically corrected CHD who require ECMO. The complexity of cardiac surgery and delayed initiation of ECMO are associated with prolonged ECMO stay duration. Proper timing of ECMO Initiation may reduce complications and improve survival.