Journal of the American Heart Association · 2026
Extracorporeal Membrane Oxygenation in the Interstage Period After Norwood and Related Stage I Palliations in Infants With Single Ventricle: A Systematic Review of Incidence, Risk Factors, and Outcomes.
СтатьяСистематический обзорПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Li Dongzhe, Bottrell Stephen J, Horton Stephen B, Brizard Christian P, Pepe Salvatore
Аннотация
BACKGROUND: Neonates with congenital univentricular conditions require staged palliation culminating in a Fontan circulation to support survival. The first-stage Norwood procedure carries substantial risk of myocardial dysfunction, frequently necessitating extracorporeal membrane oxygenation (ECMO) support. The aim of this systematic review was to examine the incidence, risk factors, and outcomes of post-Norwood ECMO use during the interstage period.
METHODS: We systematically searched MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov for studies published between January 1990 and March 2026 reporting ECMO use following Norwood procedures. Studies evaluating ECMO as part of postoperative management strategies were included.
RESULTS: From 1509 identified studies, 15 met inclusion criteria, encompassing 4030 patients. The pooled incidence of post-Norwood ECMO was 18.1% (685/3775 patients), ranging from 15.5% to 29.4% across studies. In-hospital survival among ECMO-supported patients ranged from 28.6% to 50%, with no clear temporal improvement. Risk factors for ECMO initiation included low birth weight (<2.5 kg), prolonged cardiopulmonary bypass time, moderate-to-severe preoperative atrioventricular valve regurgitation, and complex cardiac anatomy (aortic atresia, diminutive ascending aorta). Factors associated with poor outcomes included prolonged ECMO duration and ECMO-related complications, particularly neurological events, renal failure, and bleeding.
CONCLUSIONS: Despite increasing post-Norwood ECMO use, survival outcomes remain poor. Identified risk factors may inform prospective risk stratification strategies, early identification of high-risk patients, and evidence-based decision-making regarding ECMO initiation, continuation, or withdrawal in this vulnerable population. Significant heterogeneity across studies precluded meta-analysis, highlighting the need for standardized reporting in future research.
METHODS: We systematically searched MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov for studies published between January 1990 and March 2026 reporting ECMO use following Norwood procedures. Studies evaluating ECMO as part of postoperative management strategies were included.
RESULTS: From 1509 identified studies, 15 met inclusion criteria, encompassing 4030 patients. The pooled incidence of post-Norwood ECMO was 18.1% (685/3775 patients), ranging from 15.5% to 29.4% across studies. In-hospital survival among ECMO-supported patients ranged from 28.6% to 50%, with no clear temporal improvement. Risk factors for ECMO initiation included low birth weight (<2.5 kg), prolonged cardiopulmonary bypass time, moderate-to-severe preoperative atrioventricular valve regurgitation, and complex cardiac anatomy (aortic atresia, diminutive ascending aorta). Factors associated with poor outcomes included prolonged ECMO duration and ECMO-related complications, particularly neurological events, renal failure, and bleeding.
CONCLUSIONS: Despite increasing post-Norwood ECMO use, survival outcomes remain poor. Identified risk factors may inform prospective risk stratification strategies, early identification of high-risk patients, and evidence-based decision-making regarding ECMO initiation, continuation, or withdrawal in this vulnerable population. Significant heterogeneity across studies precluded meta-analysis, highlighting the need for standardized reporting in future research.