Does Single Ventricle Physiology Affect Survival of Children Requiring Extracorporeal Membrane Oxygenation Support Following Cardiac Surgery?

Abstract

The ECMO is valuable in patients with SV however results depend on anatomy, procedure, and support indication. Persistent markers of poor perfusion, end-organ injury, and prolonged ECMO duration are associated with mortality. Those factors could be modified by early ECMO application before organ damage, meticulous homeostasis to ensure adequate perfusion, early diagnosis, and reoperation on residual lesions to expedite weaning.

How Does One Use Extracorporeal Cardiopulmonary Resuscitation Risk Factor Data?*

“…Odds of survival were found to be significantly lower in patients who required support beyond 96 hours in the study by Jolley et al (1). This is consistent with multiple single-center reports that have identified an inflection point for survival after 4 days of support (2,(5)(6)(7)(8).…”

“…Although several centers (6)(7)(8) failed to identify CPR duration as a predictor of ECPR survival, the median duration of CPR was greater than 30 minutes in these studies, and the observed difference in CPR duration between survivors and nonsurvivors was generally small (< 5 min). Taken together, these findings suggest improved survival for children who receive ECLS within 30 minutes of cardiac arrest (5,12).…”

“…Body weight, renal failure, and duration of support are consistently reported as risk factors for poor outcome in neonates who receive ECLS (1,2,4,5). Odds of survival were found to be significantly lower in patients who required support beyond 96 hours in the study by Jolley et al (1).…”

Extracorporeal cardiopulmonary resuscitation

“…Despite this finding, a survival benefit of ECPR was observed even after prolonged (>60 min) CPR, with 18% ECPR vs. 0% conventional CPR patients in this category surviving to hospital discharge. Currently available data do not support the use of duration of pre-ECLS resuscitation as a contraindication to ECPR but suggest that the shorter duration (≤30 min) of ECLS resuscitation is associated with better survival (24,30).…”

Late Outcomes of Infants Supported by Extracorporeal Membrane Oxygenation Following the Norwood Operation

“…[10][11][12][13][14] Although initial experience with ECMO was largely related to patients with two ventricle cardiac malformations, the application of ECMO in SV patients gradually increased, and many studies reported hospital survival that was comparable to that in patients with two ventricle malformations. 6,7,15,16 Approximately, 10% to 20% of neonates undergoing the Norwood operation require postoperative ECMO support with reported hospital survival ranging between 30% and 60%. [3][4][5][17][18][19][20][21] Nonetheless, few studies suggested that those patients continue to be prone to high attrition risk following hospital discharge, with only a few patients reaching the Fontan final stage palliation or having late survival.…”