Objectives Extracorporeal membrane oxygenation (ECMO) is widely used to treat cardiopulmonary failure after congenital heart surgery. This study evaluated patient characteristics, outcomes, and risk factors associated with perioperative venoarterial ECMO use.Methods All patients undergoing congenital heart surgery between 2001 and 2024 at our centre were included. Prevalence, outcomes, risk factors for ECMO support, and predictors of in-hospital mortality following ECMO were analysed.Results Among 9892 congenital heart surgeries, ECMO was required in 178 (1.8%) for a median of 6 days (interquartile range IQR 4-9). Median age and weight at surgery were 2.8 months (IQR 0.4-25.2) and 4.1 kg (IQR 3.2-8.9), respectively. In patients ≤2 years, the Norwood procedure and surgery for coronary artery malformations were independent risk factors for ECMO support. Successful weaning was achieved in 62% (n = 111), while 17% (n = 30) required a second ECMO run. In-hospital mortality after ECMO was 55% (n = 98), occurring a median of 16 days (IQR 5-34) after surgery; 27% died after a successful first weaning. Model-based predictions showed an eight-fold increase between days 6 and 12 of ECMO support, with predicted mortality rising from 26% to 74%.Conclusions Approximately 2% of patients undergoing congenital heart surgery require ECMO with overall survival around 50%. Prolonged ECMO duration and acute renal failure requiring renal replacement therapy were independently associated with mortality. The sharp increase in mortality beyond six days of ECMO highlights the need for early reassessment of reversibility and timely consideration of alternative strategies.
Schaeffer et al. (Sat,) studied this question.