Skip to main content
SpringerLink
Log in

Outcomes of Extracorporeal Membrane Oxygenation in Patients After Repair of Congenital Heart Defects

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Extracorporeal membrane oxygenation (ECMO) is widely used after congenital heart surgery. The purpose of this study is to analyze the factors influencing mortality and morbidity in patients who require ECMO support after congenital cardiac surgery. All 109 patients (5.8% of total cases) who underwent ECMO support after congenital heart surgery between January 2014 and 2021 were included in this single-center study. The mean age was 10.13 ± 20.55 months, and the mean weight was 6.41 ± 6.79 kg. 87 (79.8%) of the patients were under 1 year of age. A total of 54 patients (49.5%) were weaned successfully from ECMO support, and 27 of them (24.8%) were discharged. The childhood age group had the best outcomes. Seventy-seven percent of the children were weaned successfully, and 50% were discharged. 69 patients (63.3%) had biventricular physiology; weaning and survival outcomes were better than single ventricle patients (P-value 0.002 and < 0.001, respectively). Low cardiac output (n = 49; 44.9%) as an ECMO indication had better outcomes than extracorporeal cardiopulmonary resuscitation (n = 31; 28.4%) (P = 0.05). Most of the patients had ≥ 4 Modified Aristotle Comprehensive Complexity (MACC) levels, and higher MACC levels were associated with a higher mortality rate. The most common procedure was the Norwood operation (16.5%), with the worst outcome (5.5% survival). Bleeding and renal complications were the most common complications affecting outcomes. Results were more satisfactory in patients with biventricular repair, childhood, and lower MACC levels. Early initiation of ECMO in borderline patients without experiencing cardiac arrest or multiorgan failure may improve outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Brunetti MA, Gaynor JW, Retzloff LB, Lehrich JL, Banerjee M, Amula V, Bailly D, Klugman D, Koch J, Lasa J, Pasquali SK, Gaies M (2018) Characteristics, risk factors, and outcomes of extracorporeal membrane oxygenation use in pediatric cardiac ICUs: a report from the pediatric cardiac critical care consortium registry. Pediatr Crit Care Med 19(6):544–552. https://doi.org/10.1097/PCC.0000000000001571

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bratton SL, Chan T, Barrett CS, Wilkes J, Ibsen LM, Thiagarajan RR (2017) Metrics to assess extracorporeal membrane oxygenation utilization in pediatric cardiac surgery programs. Pediatr Crit Care Med 18(8):779–786. https://doi.org/10.1097/PCC.0000000000001205

    Article  PubMed  Google Scholar 

  3. Ergün S, Yildiz O, Güneş M, Akdeniz HS, Öztürk E, Onan İS, Güzeltaş A, Haydin S (2020) Use of extracorporeal membrane oxygenation in postcardiotomy pediatric patients: parameters affecting survival. Perfusion 35(7):608–620. https://doi.org/10.1177/0267659119897746

    Article  PubMed  Google Scholar 

  4. Mascio CE, Austin EH 3rd, Jacobs JP, Jacobs ML, Wallace AS, He X, Pasquali SK (2014) Perioperative mechanical circulatory support in children: an analysis of the society of thoracic surgeons congenital heart surgery database. J Thorac Cardiovasc Surg 147(2):658–64. https://doi.org/10.1016/j.jtcvs.2013.09.075 (discussion 664–5)

    Article  PubMed  Google Scholar 

  5. Kumar TK, Zurakowski D, Dalton H, Talwar S, Allard-Picou A, Duebener LF, Sinha P, Moulick A (2010) Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome. J Thorac Cardiovasc Surg 140(2):330-336.e2. https://doi.org/10.1016/j.jtcvs.2010.02.034

    Article  PubMed  Google Scholar 

  6. Erek E, Aydın S, Suzan D, Yıldız O, Altın F, Kırat B, Demir IH, Ödemiş E (2017) Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery. Anatol J Cardiol 17(4):328–333. https://doi.org/10.14744/AnatolJCardiol.2016.6658

    Article  PubMed  Google Scholar 

  7. Nasr VG, Faraoni D, DiNardo JA, Thiagarajan RR (2016) Association of hospital structure and complications with mortality after pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med 17(7):684–691. https://doi.org/10.1097/PCC.0000000000000723

    Article  PubMed  Google Scholar 

  8. Karamlou T, Vafaeezadeh M, Parrish AM, Cohen GA, Welke KF, Permut L, McMullan DM (2013) Increased extracorporeal membrane oxygenation center case volume is associated with improved extracorporeal membrane oxygenation survival among pediatric patients. J Thorac Cardiovasc Surg 145(2):470–475. https://doi.org/10.1016/j.jtcvs.2012.11.037

    Article  PubMed  Google Scholar 

  9. Extracorporeal Life Support Organization (ELSO). Registry of the Extracorporeal Life Support Organization. Ann Arbor, MI: ELSO https://www.elso.org/Registry/Statistics/InternationalSummary.aspx. Accessed Jan 2019

  10. Erek E, Yalçınbaş YK, Sarıosmanoğlu N et al (2021) First harvest of pediatric and congenital heart surgery multicenter database in turkey: novel application of real-time online reporting. World J Pediatr Congenit Heart Surg 12(3):377–386. https://doi.org/10.1177/2150135121995474

    Article  PubMed  Google Scholar 

  11. The Extracorporeal Life Support Organization (ELSO). Extracorporeal Life Support Organization (ELSO) general guidelines for all ECLS cases. https://www.elso.org/Portals/0/Files/elsoanticoagulationguideline8-2014-table-contents.pdf. Accessed Jan 2021

  12. ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support Extracorporeal Life Support Organization, Version 1.3 November 2013 Ann Arbor, MI, USA. http://www.elsonet.org. Accessed Dec 2021

  13. Ortuno S, Delmas C, Diehl JL, Bailleul C, Lancelot A, Naili M, Cholley B, Pirracchio R, Aissaoui N (2019) Weaning from veno-arterial extracorporeal membrane oxygenation: which strategy to use? Ann Cardiothorac Surg 8(1):E1–E8. https://doi.org/10.21037/acs.2018.08.05

    Article  PubMed  PubMed Central  Google Scholar 

  14. Jaggers JJ, Forbess JM, Shah AS, Meliones JN, Kirshbom PM, Miller CE, Ungerleider RM (2000) Extracorporeal membrane oxygenation for infant postcardiotomy support: significance of shunt management. Ann Thorac Surg 69(5):1476–1483. https://doi.org/10.1016/s0003-4975(00)01330-8

    Article  CAS  PubMed  Google Scholar 

  15. Botha P, Deshpande SR, Wolf M, Heard M, Alsoufi B, Kogon B, Kanter K (2016) Extracorporeal membrane oxygenator support in infants with systemic-pulmonary shunts. J Thorac Cardiovasc Surg 152(3):912–918. https://doi.org/10.1016/j.jtcvs.2016.03.075

    Article  PubMed  Google Scholar 

  16. Allan CK, Thiagarajan RR, del Nido PJ, Roth SJ, Almodovar MC, Laussen PC (2007) Indication for initiation of mechanical circulatory support impacts survival of infants with shunted single-ventricle circulation supported with extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 133(3):660–667. https://doi.org/10.1016/j.jtcvs.2006.11.013

    Article  PubMed  Google Scholar 

  17. Wu Y, Zhao T, Li Y, Wu S, Wu C, Wei G (2020) Use of extracorporeal membrane oxygenation after congenital heart disease repair: a systematic review and meta-analysis. Front Cardiovasc Med 11(7):583289. https://doi.org/10.3389/fcvm.2020.583289

    Article  CAS  Google Scholar 

  18. Kane DA, Thiagarajan RR, Wypij D, Scheurer MA, Fynn-Thompson F, Emani S, del Nido PJ, Betit P, Laussen PC (2010) Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 122(11 Suppl):S241–S248. https://doi.org/10.1161/CIRCULATIONAHA.109.928390

    Article  CAS  PubMed  Google Scholar 

  19. Ford MA, Gauvreau K, McMullan DM, Almodovar MC, Cooper DS, Rycus PT, Thiagarajan R (2016) Factors associated with mortality in neonates requiring extracorporeal membrane oxygenation for cardiac indications: analysis of the extracorporeal life support organization registry data. Pediatr Crit Care Med 17(9):860–870. https://doi.org/10.1097/PCC.0000000000000842

    Article  PubMed  Google Scholar 

  20. Gupta P, Robertson MJ, Beam B, Gossett JM, Schmitz ML, Carroll CL, Edwards JD, Fortenberry JD, Butt W (2015) Relationship of ECMO duration with outcomes after pediatric cardiac surgery: a multi-institutional analysis. Minerva Anestesiol 81(6):619–627

    CAS  PubMed  Google Scholar 

  21. Roeleveld PP, Mendonca M (2019) Neonatal cardiac ECMO in 2019 and beyond. Front Pediatr 21(7):327. https://doi.org/10.3389/fped.2019.00327

    Article  Google Scholar 

  22. Brown G, Moynihan KM, Deatrick KB, Hoskote A, Sandhu HS, Aganga D, Deshpande SR, Menon AP, Rozen T, Raman L, Alexander PMA (2021) Extracorporeal Life Support Organization (ELSO): guidelines for pediatric cardiac failure. ASAIO J 67(5):463–475. https://doi.org/10.1097/MAT.0000000000001431

    Article  PubMed  Google Scholar 

  23. Ford MA, Gauvreau K, McMullan DM, Almodovar MC, Cooper DS, Rycus PT et al (2016) Factors associated with mortality in neonates requiring extracorporeal membrane oxygenation for cardiac indications. Pediatr Crit Care Med 17(9):860–870

    Article  Google Scholar 

  24. Şık G, Demirbuğa A, Annayev A, Temur B, Aydın S, Demir Hİ, Erek E, Çıtak A (2020) Clinical and laboratory predictors of survival for pediatric patients on non-postcardiotomy extracorporeal membrane oxygenation (ECMO). Turk J Pediatr 62(1):24–34. https://doi.org/10.24953/turkjped.2020.01.004

    Article  PubMed  Google Scholar 

  25. Chaturvedi RR, Macrae D, Brown KL, Schindler M, Smith EC, Davis KB, Cohen G, Tsang V, Elliott M, de Leval M, Gallivan S, Goldman AP (2004) Cardiac ECMO for biventricular hearts after paediatric open heart surgery. Heart 90(5):545–551. https://doi.org/10.1136/hrt.2002.003509

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Alsoufi B, Awan A, Manlhiot C, Guechef A, Halees ZA, Ahmadi MA et al (2014) Results of rapid -response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery. Eur J Cardio-Thorac Surg 45:268–275

    Article  Google Scholar 

  27. Basgoze S, Temur B, Guvenc O, Aydin S, Guzelmeric F, Onalan M, Erek E (2021) Analysis of outcomes in patients with abnormal laterality undergoing congenital heart surgery. Cardiol Young. https://doi.org/10.1017/S1047951121003899

    Article  PubMed  Google Scholar 

  28. Oka N, Wang L, Mi W, Zhu W, Honjo O, Caldarone CA (2008) Cyclosporine a prevents apoptosis-related mitochondrial dysfunction after neonatal cardioplegic arrest. J Thorac Cardiovasc Surg 135:123–130

    Article  CAS  Google Scholar 

  29. Petrucci O, O’Brien SM, Jacobs ML, Jacobs JP, Manning PB, Eghtesady P (2011) Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg 92:642–51 (discussion 651-2)

    Article  Google Scholar 

  30. Yu X, Yang Y, Zhang W, Guo Z, Shen J, Xu Z, Zhang H, Wang W (2021) Postcardiotomy extracorporeal membrane oxygenation in neonates. Thorac Cardiovasc Surg 69(S 03):e41–e47. https://doi.org/10.1055/s-0041-1730034

    Article  PubMed  PubMed Central  Google Scholar 

  31. Alsoufi B, Awan A, Manlhiot C, Halees ZA, Ahmadi MA, McCrindleB W et al (2014) Does single ventricle physiology affect survival of children requiring extracorporeal membrane oxygenation support following cardiac surgery? World J Pediatr Congenit Heart Surg 5(1):7–15

    Article  Google Scholar 

  32. Guo Z, Yang Y, Zhang W, Shen J, Jiang L, Yu X, Wang W (2019) Extracorporeal cardiopulmonary resuscitation in children after open heart surgery. Artif Organs 43(7):633–640. https://doi.org/10.1111/aor.13408

    Article  CAS  PubMed  Google Scholar 

  33. Mehta A, Ibsen LM (2013) Neurologic complications and neurodevelopmental outcome with extracorporeal life support. World J Crit Care Med 2:40–7

    Article  Google Scholar 

  34. Polito A, Barrett CS, Wypij D, Rycus PT, Netto R, Cogo PE, Thiagarajan RR (2013) Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO registry data. Intensive Care Med 39(9):1594–601. https://doi.org/10.1007/s00134-013-2985-x

    Article  CAS  PubMed  Google Scholar 

  35. Merrill ED, Schoeneberg L, Sandesara P, Molitor-Kirsch E, O’Brien J Jr, Dai H, Raghuveer G (2014) Outcomes after prolonged extracorporeal membrane oxygenation support in children with cardiac disease—Extracorporeal Life Support Organization registry study. J Thorac Cardiovasc Surg 148(2):582–588. https://doi.org/10.1016/j.jtcvs.2013.09.038

    Article  PubMed  Google Scholar 

  36. Hraska V, Ksellman A, Haun C (2014) Patient selection criteria are needed for extracorporeal cardiopulmonary resuscitation following cardiac surgery. Eur J Cardiothorac Surg 45:276–277

    Article  Google Scholar 

  37. Agarwal HS, Hardison DC, Saville BR, Donahue BS, Lamb FS, Bichell DP, Harris ZL (2014) Residual lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation support. J Thorac Cardiovasc Surg 147(1):434–441. https://doi.org/10.1016/j.jtcvs.2013.03.021

    Article  PubMed  Google Scholar 

  38. Howard TS, Kalish BT, Wigmore D, Nathan M, Kulik TJ, Kaza AK, Williams K, Thiagarajan RR (2016) Association of extracorporeal membrane oxygenation support adequacy and residual lesions with outcomes in neonates supported after cardiac surgery. Pediatr Crit Care Med 17(11):1045–1054. https://doi.org/10.1097/PCC.0000000000000943

    Article  PubMed  Google Scholar 

Download references

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    Serdar Basgoze, Bahar Temur, Selim Aydın & Ersin Erek

  2. Department of Anesthesiology, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    Fusun Guzelmeric & Muzeyyen Iyigun

  3. Department of Pediatric Cardiology, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    Osman Guvenc & Ayhan Cevik

  4. Department of Pediatric Cardiac Surgery, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Halkali, 34303, Istanbul, Turkey

    Serdar Basgoze

Authors
  1. Serdar Basgoze
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bahar Temur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Selim Aydın
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fusun Guzelmeric
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Osman Guvenc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ayhan Cevik
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Muzeyyen Iyigun
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ersin Erek
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SB: Conceptualization, Project administration, Software, Writing—original draft. BT: Data curation, Visualization, Writing—review & editing. SA: Formal Analysis. FG: Formal Analysis. OG: Data curation, Investigation. AC: Investigation, Methodology, Supervision, Validation. MI: Data curation, Visualization. EE: Conceptualization, Project administration, Supervision, Validation, Writing—review & editing.

Corresponding author

Correspondence to Serdar Basgoze.

Ethics declarations

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Basgoze, S., Temur, B., Aydın, S. et al. Outcomes of Extracorporeal Membrane Oxygenation in Patients After Repair of Congenital Heart Defects. Pediatr Cardiol 43, 1811–1821 (2022). https://doi.org/10.1007/s00246-022-02918-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-022-02918-9

Keywords

Search

Navigation