Outcomes of Modified Extracorporeal Membrane Oxygenation Using A Cardiopulmonary Bypass Circuit in Postcardiotomy Children With Congenital Heart Disease—A Ten-Year Experience From a Resource-Limited Center

Abstract

Objectives: Extracorporeal membrane oxygenation (ECMO) plays a crucial role in the outcome of children following surgery for congenital heart disease. However, its availability and affordability are minimal across the globe. We present our experience with a modified ECMO circuit using a conventional cardiopulmonary bypass (CPB) oxygenator in postcardiotomy children following surgical repair of congenital heart disease. Material and Methods: The data were collected retrospectively by screening all pediatric cardiac surgery patients from June 2014 to December 2024. A total of 3,527 patients underwent surgery for congenital heart disease. The modified ECMO circuit was used in a total of 34/3,527 (0.9%) patients following congenital cardiac surgery during this period. Data on demographics, surgical details, indications, and duration of modified ECMO, complications, successful decannulation, and hospital discharge were collected from electronic health records. Kaplan-Meier was used to plot hospital stay and in-hospital mortality with respect to successful decannulation. Results: The median duration of support with the modified ECMO circuit was 39 hours (IQR 24-56). Successful decannulation was accomplished in 20/34 patients (58.8%), and 11/34 patients (32.3%) went home alive from the hospital. Complications encountered included renal dysfunction (39.4% [13/34]), bleeding (35.2% [12/34]), seizures (8.8% [3/34]), and stroke (5.8% [2/34]). Conclusion: The modified ECMO circuit, derived from the conventional CPB circuit, offers a cost-effective solution for short-term cardiac support in pediatric cardiac surgery. Survival rates and complications suggest its viability, particularly in resource-limited settings.