Outcomes after hospital discharge in children requiring post-cardiotomy extracorporeal membrane oxygenation: A binational retrospective cohort study

Abstract

Objectives: To describe longer-term survival and morbidity outcomes after hospital discharge in a binational cohort of children who required extracorporeal membrane oxygenation after cardiac surgery.; Methods: This was a retrospective cohort study from the Australia and New Zealand Congenital Outcomes Registry for Surgery database. All patients younger than 18 years of age (n = 12,290) undergoing pediatric cardiac surgical procedures between January 1, 2013, and December 31, 2021, who required post-cardiotomy extracorporeal membrane oxygenation in the same admission were included.; Results: Among 376 (3%) patients who required post-cardiotomy extracorporeal membrane oxygenation, 242 (64.4%) survived to hospital discharge. Median follow-up in survivors posthospital discharge was 4.2 years (interquartile range, 2.6-8 years). Kaplan-Meier survival at 1, 3, 5, and 8 years was 62%, 58.5%, 55.8%, and 52.6%. Postdischarge survival was 95.5%, 90.7%%, 87.1%, and 81.9% at 1, 3, 5, and 8 years, respectively. Survival was significantly poorer in patients with single-ventricle physiology. In total, 43.3% (n = 105) of hospital survivors had at least 1 major morbidity at the last follow-up. The most common major morbidities were developmental delay, permanent neurologic deficits, and growth restriction.; Conclusions: In total, 38% of children who required ECMO after cardiac surgery did not survive beyond 1 year. However, of patients who survived to hospital discharge, 95% were alive at 1 year. Approximately 80% of patients were alive at 5 years after hospital discharge. Outcomes were poorer in patients with single-ventricle physiology. In total, 40% of patients had significant morbidity after hospital discharge.; Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)