ECMO experience in ACHD ICU in Texas Children’s Hospital

Background:

Background: Extracorporeal Membrane Oxygenation (ECMO) plays a crucial role in the management of critically ill patients in shock. The unique anatomy and physiology of adult congenital heart disease (ACHD) patients may complicate the application of ECMO. We review our four year experience from a dedicated ACHD ICU.

Methods:

Methods: Retrospective analysis of ACHD patients (age ≥ 16 yo) supported with venoarterial (VA) or venovenous (VV) ECMO over a four-year period (2021–2024) at Texas Children’s Hospital. Data was abstracted on demographics, clinical characteristics, indication, configuration and duration of ECMO, and survival

Outcome: Outcomes: A total of 29 ACHD patients were supported with 33 instances of ECMO in a 4 year time period where 660 ICU admissions occurred. The median age of ECMO patients was 27 y (range 17-56). Annual distributions were: 5 cases in 2021, 10 cases in 2022, 10 cases in 2023, and 8 cases in 2024. VV ECMO use declined with the waning of COVID (3/5 in 2021, 4/10 in 2022, 2/10 in 2023 and 1/8 in 2024). Median duration of ECMO was 170 h and was longer in VV than VA ECMO. Overall mortality was low (24%) and similar between patients supported with VA (5/19) vs. VV (2/10) The primary diagnoses leading to ECMO support included myocarditis and COVID-19 in 2021, congenital heart disease-related complications in 2022, and post transplant rejection and ACHD with decompensated heart failure in 2023 and 2024.

Conclusion: ACHD patients requiring ECMO are primarily younger adults. ECMO was provided for both respiratory and cardiac indications, the former requiring longer duration. The survival outcomes were uniformly good compared to national averages. In specialized ACHD ICU, ECMO support in carefully selected patients has good outcomes despite complex anatomy and physiology