Background:

Patients with adult congenital heart disease (ACHD) now outnumber pediatric patients with congenital heart disease (CHD). The use of postcardiotomy extracorporeal membrane oxygenation (ECMO) support for ACHD patients is limited. The use of ECMO for nonsurgical indications in ACHD patients has rarely been described.

Methods:

We conducted a retrospective review of the Extracorporeal Life Support Organization (ELSO) registry of adult patients with CHD who received ECMO between 2009-2019 for medical indications; excluding patients who received ECMO post-cardiotomy. We evaluated all ACHD patients supported on ECMO for medical indications. The primary outcome was survival to hospital discharge and secondary outcomes were ECMO-related complications.

Results:

There were 312 ACHD patients were supported on ECMO for medical indications with a mortality of 57.1%. Seventy (22.4%) patients went on to require a surgical or catheter-based intervention while on/after ECMO with no difference in mortality (p= 0.59) compared to those who did not receive a surgical intervention. Patients who underwent eCPR or ECMO support for pulmonary indications were less likely to undergo any procedure (p= 0.02) compared for cardiac indications. Acute kidney injury (p< 0.01) and liver disease (p< 0.01) were associated with mortality. ECMO related complications were associated with mortality: cardiovascular (p< 0.01), hemorrhagic (p< 0.01), metabolic (p< 0.01), pulmonary (p< 0.01), renal (p< 0.01) and limb (p= 0.03).

Conclusion:

ACHD patients placed on ECMO have high mortality, with worse outcomes for those with renal and liver disease, and if they sustained an ECMO-related complication.