Ventricular Arrhythmias During Extracorporeal Circulatory Support for Cardiac Indications: Outcomes in a Single-Center Retrospective Cohort, 2020-2023.

OBJECTIVES: Venoarterial extracorporeal membrane oxygenation (ECMO) can be used for pediatric patients in heart failure because of congenital or acquired heart disease. Even though these patients are at risk of arrhythmias, data are limited regarding the prevalence and types of arrhythmias, and their association with adverse outcomes. We present our single-center experience of arrhythmia during pediatric cardiac ECMO support, and the associated outcomes. DESIGN: Single-center, retrospective cohort, 2020-2023. SETTING: Cardiac ICU in a quaternary care center in New York. PATIENTS: Pediatric patients requiring ECMO for cardiac indications, including extracorporeal cardiopulmonary resuscitation, cardiogenic shock, hypoxemia secondary to lack of pulmonary blood flow, or inability to wean from cardiopulmonary bypass. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified 74 patients undergoing 83 ECMO runs during 2020-2023. Arrhythmias occurred in 27 of 83 ECMO runs (33% [95% CI, 23-44%]), including ventricular arrhythmias in 14 of 83 runs (17%). We did not identify an association between any arrhythmia while on ECMO support and death or heart transplantation. However, ventricular arrhythmias were associated with greater hazard (using hazard ratio [HR]) of death or heart transplantation (HR, 5.7 [95% CI, 1.2-27.8]; p = 0.03). Similarly, we failed to identify an association between any arrhythmia on ECMO and wean failure (p = 0.09); however, ventricular arrhythmias on ECMO were associated with greater hazard of wean failure (HR, 18.8 [95% CI, 2.9-121]; p = 0.002). Any arrhythmia on ECMO was also associated with longer ECMO duration (189 vs. 90.1 hr; p < 0.001), particularly ventricular arrhythmias (335 vs. 94 hr; p < 0.001). CONCLUSIONS: In our 2020-2023, single-center experience in pediatric cardiac cases requiring venoarterial ECMO support for cardiac failure, the prevalence of arrhythmias was substantial (one-in-three ECMO runs). Of note, ventricular arrhythmias on ECMO were associated with greater hazard of transplant-free survival, ECMO wean failure, and prolonged ECMO duration.