Perioperative extracorporeal membrane oxygenation in neonates with transposition of the great arteries: 15 years of experience

Abstract

Objectives: Extracorporeal membrane oxygenation (ECMO) can act as a bridge to recovery in both pre- and postoperative patients with transposition of the great arteries (TGA). However, literature on its use in these patients is scarce.

Methods: Retrospective single-centre cohort study encompassing all TGA patients who received ECMO between January 2009 and March 2024.

Results: Twenty-two neonates received ECMO during the study period, with an overall median age and weight at time of ECMO cannulation of 6.5 (1.8-10) days and 3.7 (3.3-4.0) kg, respectively. Twelve neonates received ECMO prior to the arterial switch operation because of severe persistent pulmonary hypertension (83%), respiratory failure due to severe pulmonary atelectasis (8%) or hypoxia after pulmonary arterial banding procedure (8%). Postoperative ECMO was used in 11 patients; of these, 1 (9%) had also received ECMO preoperatively. Postoperative indications for the remaining patients included failure to wean from cardiopulmonary bypass (50%), low cardiac output in Intensive Care Unit (20%), or after cardiopulmonary arrest (30%). Overall, median ECMO duration for all TGA patients was 75 (45-171) h, with a survival rate of 59% to hospital discharge. Among the preoperative ECMO patients, 5 patients (42%) died (4 preoperatively, 1 postoperatively performed while on ECMO). In the postoperative ECMO group, survival rate was 60%.

Conclusions: In this single-centre retrospective study, TGA neonates received ECMO preoperatively primarily for severe pulmonary hypertension and postoperatively for failure to wean from cardiopulmonary bypass. This study showed a 58% and 60% survival to hospital discharge in ECMO patients supported preoperatively and those supported postoperatively, respectively.

Keywords: Extracorporeal Membrane Oxygenation; Paediatric Intensive Care Units; Paediatric critical care; Persistent pulmonary hypertension of the newborn; Transposition of the Great Vessels.