Use of Extracorporeal Membrane Oxygenation After Congenital Heart Disease Repair: A Systematic Review and Meta-Analysis

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) has been widely used to treat cardiopulmonary failure in patients with congenital heart defects (CHD) postoperatively. A meta-analysis is performed for outcomes of postoperative CHD patients on ECMO. Methods: Electronic databases, including PubMed, EMbase, and Cochrane Library CENTRAL were searched systematically from January 1990 to June 2020 for literature which reported the outcomes of postoperative CHD cases on ECMO. The scope of this search was restricted to articles published in English. Results: Forty-three studies were included in this study, involving 3,585 subjects. Postoperative ventricular failure with low cardiac output was the most common indication of ECMO initiation. The pooled estimated incidence of in-hospital mortality was 56.8% (95% CI, 52.5–61.0%). Bleeding was the most common complication with ECMO with an incidence of 47.1% (95% CI, 38.5–55.8%). Multivariate meta-regression analysis revealed that single ventricular physiology (coefficient 0.213, 95% CI 0.099–0.327, P = 0.001) and renal failure (coefficient 0.315, 95% CI 0.091–0.540, P = 0.008) were two independent risk factors for in-hospital mortality. Conclusions: There is an overall high in-hospital mortality of 56.8% in postoperative CHD patients on ECMO. Bleeding is the most common complication during ECMO running with an incidence of 47.1%. Single ventricular physiology and renal failure, as two independent risk factors, may potentially increase in-hospital mortality. Further studies exploring the differences in outcomes between ECMO and other extracorporeal life support strategies are warranted.

Short‐Term Mortality Among Pediatric Patients With Heart Diseases Undergoing Veno‐Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta‐Analysis

“… 33 A discrepancy between our pooled short‐term mortality of 45.6% and the above‐mentioned mortalities may be explained in part by the variance of patient selection and various VA‐ECMO managements without harmonized guidelines. Consistent with previous data, 39 , 47 , 48 , 49 , 50 , 51 in our subgroup analysis by diseases, the short‐term mortality of CHD and AFM were 51.5% and 21.6%, respectively. The significant difference ( P <0.001) suggested that patients with AFM had more favorable outcome than CHD.…”

A narrative review of modern approach and outcomes evaluation in congenital heart defects

“…Furthermore, significant advances in perioperative support to critically ill infants and children with congenital heart defects have been achieved with readily available and improved extracorporeal membrane oxygenation techniques. Expanded knowledge of extracorporeal membrane oxygenation indications and timing, cannulations strategies, anticoagulation management, extracorporeal membrane oxygenation circuit assessment and optimal flow rates have allowed clinicians to provide improved cardio-circulatory support and mitigate patient complications (33)(34)(35).…”

National In-Hospital Outcomes of Mechanical Mitral Valve Replacement in the Pediatric Population

“…[22][23][24] A recent meta-analysis investigating outcomes of patients undergoing ECMO following congenital heart surgeries by Wu and colleagues found an estimated in-hospital mortality as high as 57%, and bleeding was the most common complication in 47%. 25 The pooled overall incidence of neurological events and renal failure was 47% and 39%, respectively. Consistent with the literature, our investigation demonstrated that the incidence of patients who required intra-or postoperative ECMO due to cardiopulmonary compromise was 3.8%.…”