Factors Associated With Mortality in Patients Requiring Extracorporeal Membrane Oxygenation Following the Norwood Procedure: A Systematic Review and Meta-Analysis

Introduction Extracorporeal membrane oxygenation (ECMO) is becoming more prevalent post-Norwood procedure, and its use has been linked to reduced survival, with wide variability between centres. The reasons for this variability, particularly the roles of anatomy, surgical technique and ECMO indication, remain poorly understood. This study examines associated factors with survival to discharge in patients undergoing post-Norwood ECMO. Methods We systematically searched PubMed, EMBASE, Cochrane Central and Web of Science for relevant variables. The analysed variables included operative parameters, ECMO variables and postoperative complications during ECMO support post-Norwood procedure. Statistical analyses were performed using RevMan 5.4 to calculate pooled risk ratios, odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CIs) using random-effects models. Results A total of 8 studies were included (1614 neonates; 41% post-Norwood ECMO survivors). Cardiopulmonary bypass and ECMO durations were significantly longer in the non-survivor group (MD = −24.33, CI = −39.19 to −9.47, p = .001) and (MD = −42.76, CI = −51.65 to −33.87, p < .00001),respectively. ECMO indications and cannulation technique were similar between the groups. Important complications such as bleeding (OR = 0.67, p = .003), neurological injury (OR = 0.55, p < .0001), arrhythmia (OR = 0.45, p < .00001) and cardiac tamponade (OR = 0.49, p = .03) were all significantly greater in the cohort of neonates that did not survive to discharge. Conclusion For infants requiring ECMO support following the Norwood procedure, longer cardiopulmonary bypass times and longer ECMO duration were observed among neonates who did not survive to discharge. ECMO indications showed no clear association with survival. There was a significantly higher incidence of bleeding, neurological injury, and arrhythmia in the non-survivor cohort.