Risk Score to Assess Extracorporeal Life Support Need After Norwood Operation on Arrival to Pediatric Cardiac Intensive Care Unit

Extracorporeal life support (ECLS) is required in 8-24% of neonates following the Norwood operation and is associated with high morbidity and mortality. Early identification of patients at risk may enable timely intervention and resource optimization. We developed and internally validated a bedside risk score at arrival to the cardiac intensive care unit (CICU) to predict ECLS requirement in the first 7 days postoperatively. In a retrospective cohort of 322 neonates undergoing the Norwood procedure between January 2010 and December 2023, 71 (22%) required postoperative ECLS. Multivariable logistic regression identified six independent predictors: moderate-severe atrioventricular valve regurgitation (5 points), modified Blalock-Taussig-Thomas (m-BTT) shunt (5 points), cardiopulmonary bypass time greater than 173.5 minutes (5 points), vasoactive inotropic score greater than 19.5 on CICU arrival (7 points), delayed sternal closure (5 points), and postoperative inhaled nitric oxide use (7 points). The resulting score (range 0-29) stratified patients into low- (0-10), moderate- (12-19), and high-risk (20-29) groups, with corresponding ECLS rates of 8%, 31%, and 65%. The model demonstrated good discrimination (area under the receiver operating characteristic curve [AUC]: 0.78). This novel risk tool may support early clinical decision-making and triage in high-risk neonates following Norwood palliation. External validation is warranted to assess generalizability and clinical utility.