---
title: "Postcardiotomy ECMO After the Norwood Procedure: US Utilization, Outcomes, and Predictors"
id: "pubmed-42622839"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42622839"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42622839/"
doi: "10.1177/02184923261478983"
published_at: "2026-08-20T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Postcardiotomy ECMO After the Norwood Procedure: US Utilization, Outcomes, and Predictors
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42622839
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42622839/)
- **DOI:** [10.1177/02184923261478983](https://doi.org/10.1177%2F02184923261478983)
- **Published At:** 2026-08-20T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study assessed national trends, characteristics, and outcomes of **postcardiotomy ECMO** after the **Norwood** procedure using large inpatient databases from the United States. - Data sources included the Kids' Inpatient Database (2000–2022) and the National Inpatient Sample (2016–2022); 2,284 Norwood procedures were identified. - Overall **ECMO** use after Norwood was 6% (147 of 2,284 patients). The cohort was divided into ECMO (EG, n = 147) and non-ECMO (NEG, n = 2,137) groups; survivors and nonsurvivors were compared. - Patients who received ECMO were more likely to have hypoplastic left heart syndrome (HLHS) rather than variant anatomy, total anomalous pulmonary venous return, be small for gestational age, and present with congestive heart failure or arrhythmias. - The overall discharge **mortality** for the full cohort was 10%; mortality was higher in the ECMO group (44%) versus the non-ECMO group (8%). - ECMO-treated patients experienced greater morbidity, including cardiac arrest, pericardial complications, cardiogenic shock, respiratory complications, **acute kidney injury (AKI)**, postoperative bleeding, sepsis, and need for reoperation; they also had longer length of stay and higher hospital charges. - Temporal trends showed increasing ECMO utilization with a peak after 2015 and a concurrent progressive decline in mortality over the study period. - Regional variation existed: the Midwest reported the highest ECMO use (8.93%). - In multivariate analysis, **ECMO** use and **AKI** were independent predictors of mortality. Specific statistical parameters and effect sizes were not reported in the abstract. - Conclusion: Postcardiotomy ECMO after the Norwood procedure remains uncommon but is increasing, with notable morbidity, regional differences, and an association with postoperative AKI and higher mortality.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Impact of postcardiotomy ECMO utilization after the Norwood procedure in the United States [Rohit Ganduboina](https://pubmed.ncbi.nlm.nih.gov/?term=Ganduboina+R&cauthor_id=42622839)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#full-view-affiliation-1 "Department of Cardiothoracic Surgery, Northwell Health Cardiovascular Institute, New Hyde Park, NY, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#full-view-affiliation-2 "Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, India."), [John Karamichalis](https://pubmed.ncbi.nlm.nih.gov/?term=Karamichalis+J&cauthor_id=42622839)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#full-view-affiliation-3 "Section of Pediatric and Congenital Cardiac Surgery, Columbia University Medical Center, New York, NY, USA."), [Keerthi Palagati](https://pubmed.ncbi.nlm.nih.gov/?term=Palagati+K&cauthor_id=42622839)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#full-view-affiliation-4 "Department of General Surgery, University of Miami, Miami, FL, USA."), [Sandeep Sainathan](https://pubmed.ncbi.nlm.nih.gov/?term=Sainathan+S&cauthor_id=42622839)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#full-view-affiliation-5 "Department of Congenital Cardiac Surgery, Corewell Health, Helen Devos Children's Hospital, Grand Rapids, MI, USA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#full-view-affiliation-6 "Department of Pediatrics, Michigan State University, East Lansing, MI, USA.") Affiliations Expand ### Affiliations * 1 Department of Cardiothoracic Surgery, Northwell Health Cardiovascular Institute, New Hyde Park, NY, USA. * 2 Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, India. * 3 Section of Pediatric and Congenital Cardiac Surgery, Columbia University Medical Center, New York, NY, USA. * 4 Department of General Surgery, University of Miami, Miami, FL, USA. * 5 Department of Congenital Cardiac Surgery, Corewell Health, Helen Devos Children's Hospital, Grand Rapids, MI, USA. * 6 Department of Pediatrics, Michigan State University, East Lansing, MI, USA. * PMID: **42622839** * DOI: [ 10.1177/02184923261478983 ](https://doi.org/10.1177/02184923261478983) Item in Clipboard # Impact of postcardiotomy ECMO utilization after the Norwood procedure in the United States Rohit Ganduboina et al. Asian Cardiovasc Thorac Ann. 2026. Show details Display options Display options Format Abstract PubMed PMID Asian Cardiovasc Thorac Ann Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Asian+Cardiovasc+Thorac+Ann%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Asian+Cardiovasc+Thorac+Ann%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42622839/) . 2026 Aug 20:2184923261478983. doi: 10.1177/02184923261478983. Online ahead of print. ### Authors [Rohit Ganduboina](https://pubmed.ncbi.nlm.nih.gov/?term=Ganduboina+R&cauthor_id=42622839)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#short-view-affiliation-1 "Department of Cardiothoracic Surgery, Northwell Health Cardiovascular Institute, New Hyde Park, NY, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#short-view-affiliation-2 "Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, India."), [John Karamichalis](https://pubmed.ncbi.nlm.nih.gov/?term=Karamichalis+J&cauthor_id=42622839)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#short-view-affiliation-3 "Section of Pediatric and Congenital Cardiac Surgery, Columbia University Medical Center, New York, NY, USA."), [Keerthi Palagati](https://pubmed.ncbi.nlm.nih.gov/?term=Palagati+K&cauthor_id=42622839)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#short-view-affiliation-4 "Department of General Surgery, University of Miami, Miami, FL, USA."), [Sandeep Sainathan](https://pubmed.ncbi.nlm.nih.gov/?term=Sainathan+S&cauthor_id=42622839)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#short-view-affiliation-5 "Department of Congenital Cardiac Surgery, Corewell Health, Helen Devos Children's Hospital, Grand Rapids, MI, USA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42622839/#short-view-affiliation-6 "Department of Pediatrics, Michigan State University, East Lansing, MI, USA.") ### Affiliations * 1 Department of Cardiothoracic Surgery, Northwell Health Cardiovascular Institute, New Hyde Park, NY, USA. * 2 Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, India. * 3 Section of Pediatric and Congenital Cardiac Surgery, Columbia University Medical Center, New York, NY, USA. * 4 Department of General Surgery, University of Miami, Miami, FL, USA. * 5 Department of Congenital Cardiac Surgery, Corewell Health, Helen Devos Children's Hospital, Grand Rapids, MI, USA. * 6 Department of Pediatrics, Michigan State University, East Lansing, MI, USA. * PMID: **42622839** * DOI: [ 10.1177/02184923261478983 ](https://doi.org/10.1177/02184923261478983) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract BackgroundNorwood surgery is the first stage in the surgical palliation of hypoplastic left heart syndrome (HLHS) and its variants. Postcardiotomy extracorporeal membrane oxygenation (ECMO) may be required in some patients undergoing the Norwood procedure given its complexity.MethodsKids Inpatient Database (2000-2022) and National Inpatient Sample (2016-2022) datasets were used. 2284 patients underwent a Norwood procedure. The cohort was dichotomized into ECMO (EG, _n_ = 147) and Non-ECMO (NEG, _n_ = 2137) groups; Survivor and Nonsurvivor. Demographic and clinical characteristics were extracted. Overlap weights were used to attain covariate balance and perform overlap-weighted analysis.ResultsPostcardiotomy ECMO utilization was 6% (147/2284). The EG was more likely to have HLHS as compared to its variants, total anomalous pulmonary venous return, small for gestational age, congestive heart failure, and arrhythmias. Overall discharge mortality for the entire cohort is 10%. The EG experienced higher mortality compared to NEG "44% versus 8%" and higher morbidity such as cardiac arrest, pericardial complication, cardiogenic shock, respiratory complications, acute kidney injury (AKI), postoperative bleeding, sepsis and reoperation, longer length-of-stay, and higher hospital charges than NEG. ECMO utilization rose over time, peaking after 2015, while mortality progressively declined. The Midwest had the highest ECMO use (8.93%). In multivariate analysis, ECMO use and AKI were independent predictors of mortality.ConclusionsPostcardiotomy ECMO utilization for the Norwood procedure remains rare, but utilization is increasing with regional variation. Postoperative AKI and ECMO utilization were independent predictors of mortality among Norwood. **Keywords:** ECMO; Norwood; single ventricle palliation. 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