Abstract
ObjectivesTo describe longer-term survival and morbidity outcomes after hospital discharge in a binational cohort of children who required extracorporeal membrane oxygenation after cardiac surgery. MethodsRetrospective 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 paediatric cardiac surgical procedures between 1 January 2013 and 31 December 2021 who required post-cardiotomy extracorporeal membrane oxygenation in the same admission were included. ResultsAmong 376 (3%) patients who required post-cardiotomy extracorporeal membrane oxygenation, 242 (64.4%) survived to hospital discharge. Median follow-up in survivors post-hospital discharge was 4.2 years (IQR 2.6 – 8 years). Kaplan-Meier survival at 1, 3, 5 and 8 years was 62%, 58.5%, 55.8%, and 52.6%. Post-discharge 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. 43.3% (n=105) of hospital survivors had at least one major morbidity at the last follow-up. The most common major morbidities were developmental delay, permanent neurological deficits, and growth restriction. Conclusions38% 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 one year. Approximately 80% of patients were alive at 5 years after hospital discharge. Outcomes were poorer in patients with single ventricle physiology. 40% of patients had significant morbidity after hospital discharge.
Published Version
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