Extracorporeal membrane oxygenation in congenital cardiac surgery: a 10-year single-centre experience

Abstract Introduction: Extracorporeal Membrane Oxygenation (ECMO) has evolved as an effective mechanical support for cardiorespiratory failure in patients undergoing congenital cardiac surgery, and the threshold of using it has substantially reduced. This study presents a 10-year single-centre experience evaluating outcomes, survival, and risk factors associated with perioperative veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in paediatric congenital cardiac surgery. Methods: A retrospective review was undertaken for all patients younger than 16 years old who required ECMO during the perioperative period between January 2013 and December 2022. Patients were categorised according to the timing of ECMO initiation into pre-operative, intra-operative, immediate post-operative (<24 hours), and early post-operative (>24 hours) groups, while extracorporeal cardiopulmonary resuscitation (ECPR ECMO) cases were analysed separately using standard statistical methods. Results: A total of 150 patients required ECMO support, with overall survival to discharge of 54%. Survival was higher in patients requiring ECMO within 24 hours after surgery (57.4%) compared with those requiring ECMO later (35.1%), while ECPR ECMO patients showed 46.0% survival. Prolonged cardiopulmonary bypass time ( p = 0.017), aortic cross-clamp time ( p = 0.002), and longer ECMO duration ( p < 0.001) were significantly associated with mortality. Intracranial haemorrhage, ischaemia, sepsis, acute kidney injury, gastrointestinal complications, and mediastinal bleeding were major complications linked to increased mortality. Survival at 1 and 5 years was 50.3% and 41.6%, respectively. Conclusions: VA-ECMO remains a life-saving strategy after congenital cardiac surgery with survival exceeding 50%. Early initiation and shorter ECMO duration may improve outcomes, while prevention of major complications and careful patient selection are essential to optimise survival in paediatric cardiac centres.