Background

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a critical therapeutic intervention that is commonly used in the management of paediatric patients with congenital heart disease (CHD). This procedure can be initiated either inraoperatively or postoperatively. However, few studies have reported data on the comparative clinical outcomes associated with different timings of VA ECMO initiation. In this study, patient characteristics and clinical outcomes between intraoperative and postoperative VA ECMO in infants undergoing cardiac surgery were compared and predictors of ECMO initiation were determined, which may improve clinical outcomes.

Methods

A total of 47 infants who received postcardiotomy VA ECMO support from September 2019 to December 2023 were included in this retrospective, single-centre observational study. Patients who received VA ECMO support in the operating room (intraoperative, n = 27) were compared with those who received it in the intensive care unit (postoperative, n = 20). Kaplan‒Meier curves were further analysed for survival and perioperative factors were evaluated to predict VA ECMO initiation.

Results

Survival rates were greater in the intraoperative group (70.37% vs. 25%; P = 0.002), with a reduced risk of mortality (HR: 2.84; 95% CI: 1.23–6.55). The intraoperative group also had a higher ECMO weaning rate (88.89% vs. 45%, P < 0.001) and shorter VA ECMO duration (5.00 ± 1.80 days vs. 7.50 ± 2.76 days; P < 0.001). Continuous renal replacement therapy (CRRT) was needed in 100% of postoperative patients versus 70.40% of intraoperative patients (P = 0.014). The combination of preoperative lactate ≥ 6.495 mmol/L and cardiopulmonary bypass (CPB) time ≥ 138 min predicted the need for intraoperative VA ECMO [AUC (area under the curve): 0.893 (95% CI: 0.805–0.980, P < 0.001)].

Conclusions

Compared with postoperative VA ECMO, the use of Intraoperative VA ECMO might improve clinical outcomes in infants undergoing cardiac surgery, highlighting the potential benefits of early intervention. The significant predictive value of the CPB time and preoperative lactate level may inform future clinical practices regarding the timing of ECMO initiation in paediatric patients postcardiotomy.