SynthesisJournal of cardiothoracic surgery2026
Outcomes after extracorporeal membrane oxygenation following the norwood procedure: a systematic review and meta-analysis.
Synthesis in Journal of cardiothoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
backgroundSurvival following the Norwood procedure has improved substantially, but outcomes for the high-risk subgroup requiring postoperative extracorporeal membrane oxygenation (ECMO) remain unclear. We explored short- and intermediate-term outcomes in these neonates. MAIN BODY: We systematically searched PubMed, EMBASE, Cochrane Central and Web of Science (final search: 25 February 2025). Comparative studies reporting outcomes for patients with versus without postoperative ECMO were included. Primary outcomes were short-term mortality, secondary outcomes included stages-2-and-3 palliation completion, operative times, recovery parameters, and complications. Statistical analysis used RevMan 5.4 to calculate pooled risk ratio (RR), odds ratios (OR) or mean differences (MD) with 95% confidence intervals employing random-effects models; heterogeneity was assessed using I² statistics and Cochran's Q test. Eight studies (2,612 patients: 15% with ECMO) were included. In-hospital mortality was five times greater in the ECMO group (RR = 5.53, CI = 4.41-6.93, p = 0.0003), though survival to Glenn and Fontan completion were comparable. Cardiopulmonary bypass duration was significantly longer in the ECMO group (MD = 28.07 min, CI = 18.19-37.95, p = 0.0004). Postoperative ICU recovery was significantly prolonged for ECMO patients (MD = 10.56 days, CI = 1.28-19.83, p = 0.03), though hospital recovery was similar. Postoperative atrioventricular valve regurgitation, Norwood reoperation, delayed chest closure, unplanned reoperation or death/transplantation were comparable. Risk of bias (ROBINS-I) was formally assessed.
conclusionOur analysis supports that ECMO use post-Norwood procedure identifies a high-risk subgroup with significantly higher early-mortality and resource utilisation. However, this association must be interpreted cautiously due to heterogenous ECMO indications. Future efforts should focus on identifying modifiable risk factors to improve outcomes.
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