ECMO in newborns after congenital heart surgery: Short- and mid-term outcome

Abstract

Congenital heart defects can require neonatal surgical management whatever the severity and prognosis of the malformation. Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for refractory cardiac and/or respiratory failure that can be used as a temporary life support after heart surgery. Between 2010 and 2020, 40 newborns have been placed on ECMO after having undergone a neonatal cardiac intervention in our center. The median age and the median weight were respectively 7 [4; 9.7] days and 3 [2.8; 3.2] kg. Intra-hospital survival rate of ECMO was 47.5% and overall survival rate was 35% after a median follow-up of 3.4 years. Neurological impairment (cranial hemorrhage, seizure or stroke) was reported during ECMO in 16 (40%) patients. Nosocomial infections and acute kidney injury are also frequent complications of ECMO since 17 neonates (42.5%) needed renal replacement therapy and 18 (45%) received antibiotics for a documented bacterial infection. After univariate analysis, we demonstrated univentricular heart physiology ( P = 0.046), pulmonary hypertension ( P = 0.032) and haemorrhagic complications ( P = 0.034) were significantly associated with in-hospital mortality. This is the first study that specifically addressed neonates supported by ECMO after heart surgery. Our results are consistent with those of the existing literature and characterize the main risk factors of mortality.