Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for pediatric patients with congenital heart disease (CHD), but survival to hospital discharge does not fully reflect prognosis. Increasing focus has shifted to long-term outcomes, including neurodevelopment, organ function, and quality of life, yet prognostic factors remain poorly defined. A comprehensive synthesis is needed to guide patient selection and optimize care.
Objective: To identify prognostic factors associated with positive and negative long-term outcomes in pediatric CHD patients supported with ECMO. Methods: A systematic review was conducted using PubMed/MEDLINE, Embase, Cochrane Library, and grey literature (2016–2026). Studies were included if they evaluated clinical, temporal, or treatment-related variables in relation to long-term outcomes (≥6 months), including survival, neurodevelopment, organ function, and quality of life. Studies limited to short-term outcomes were excluded. Data were extracted across three domains: (1) timing and indication for ECMO, (2) technical and institutional factors, and (3) peri-ECMO complications and outcomes. Study quality and heterogeneity were assessed, and thematic synthesis was performed.
Results: Earlier ECMO initiation in reversible pathology and lower pre-ECMO end-organ dysfunction were associated with improved survival and neurodevelopment. Poorer outcomes were linked to prolonged ECMO duration, neurologic injury, renal failure requiring dialysis, and complex single-ventricle physiology. Additional factors, including financial burden, bridge-to-transplant use, and feeding or developmental disorders, showed uncertain prognostic significance.
Conclusions: Long-term outcomes in pediatric CHD patients on ECMO are influenced by patient factors, timing of support, and complications. Standardized outcome reporting and multicenter longitudinal studies are needed to improve prognostication and guide care.
Objective: To identify prognostic factors associated with positive and negative long-term outcomes in pediatric CHD patients supported with ECMO. Methods: A systematic review was conducted using PubMed/MEDLINE, Embase, Cochrane Library, and grey literature (2016–2026). Studies were included if they evaluated clinical, temporal, or treatment-related variables in relation to long-term outcomes (≥6 months), including survival, neurodevelopment, organ function, and quality of life. Studies limited to short-term outcomes were excluded. Data were extracted across three domains: (1) timing and indication for ECMO, (2) technical and institutional factors, and (3) peri-ECMO complications and outcomes. Study quality and heterogeneity were assessed, and thematic synthesis was performed.
Results: Earlier ECMO initiation in reversible pathology and lower pre-ECMO end-organ dysfunction were associated with improved survival and neurodevelopment. Poorer outcomes were linked to prolonged ECMO duration, neurologic injury, renal failure requiring dialysis, and complex single-ventricle physiology. Additional factors, including financial burden, bridge-to-transplant use, and feeding or developmental disorders, showed uncertain prognostic significance.
Conclusions: Long-term outcomes in pediatric CHD patients on ECMO are influenced by patient factors, timing of support, and complications. Standardized outcome reporting and multicenter longitudinal studies are needed to improve prognostication and guide care.