Clinical Outcomes and Risk Factors in Pediatric Postcardiotomy Extracorporeal Membrane Oxygenation: A Nationwide Retrospective Cohort Study

Postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) is a critical rescue therapy for pediatric patients with refractory circulatory failure following cardiac surgery. This study aimed to evaluate in-hospital mortality and identify potential risk factors for adverse outcomes in pediatric PC-ECMO patients, using data from the Chinese Society of Extracorporeal Life Support registry. We analyzed pediatric patients (< 18 years) who received PC-ECMO for circulatory support from December 2016 to April 2024. Surgical complexity was categorized using the Risk Adjustment in Congenital Heart Surgery-2 (RACHS-2) method. A total of 487 patients were included, with an overall in-hospital survival rate of 48.9%. Higher mortality was observed in neonates (61.4%) than in infants and children. Independent predictors of in-hospital mortality included RACHS-2 category 4-5 (odds ratio [OR]: 2.976, p < 0.001), aortic cross-clamp time greater than 90 minutes (OR: 1.931, p = 0.007), elevated lactate at 24 hours post-ECMO (OR: 1.221 per mmol/L, p < 0.001), and renal complications (OR: 3.135, p < 0.001). The combined model achieved an area under the curve of 0.737, outperforming the individual predictors. In-hospital mortality in pediatric patients receiving PC-ECMO remains high, and is strongly influenced by surgical complexity, aortic cross-clamp time, metabolic recovery, and renal function.