Outcomes and associated ethical considerations of long-run pediatric ECMO at a single center institution

Area of Science:

• Pediatric Critical Care Medicine
• Neonatal Intensive Care
• Cardiopulmonary Support

Background:

• Long-term extracorporeal membrane oxygenation (ECMO) outcomes in neonatal and pediatric populations are not well-documented.
• Previous studies have not extensively detailed survival and complication rates for prolonged ECMO runs.

Purpose of the Study:

• To describe the survival rates and long-term complications in pediatric patients requiring ≥21 days of ECMO.
• To test the hypothesis that prolonged ECMO support is associated with poor survival and increased long-term morbidities.

Main Methods:

• Retrospective, single-center case analysis of patients <18 years old undergoing ECMO for ≥21 continuous days.
• Comparison of outcomes between patients with prolonged ECMO runs and those with shorter durations.
• Data collection included overall survival, complication incidence, and post-discharge recovery.

Main Results:

• Overall survival for patients on ECMO ≥21 days was 36% (N=14).
• Survival was higher in patients with acquired cardiopulmonary failure (5/8) compared to those with congenital anomalies (0/6).
• Only 1 out of 5 survivors had complete recovery; others experienced significant medical and neurodevelopmental issues.

Conclusions:

• Prolonged ECMO support (≥21 days) is linked to poor survival, particularly in neonates with congenital anomalies.
• Long-term outcomes, including high rates of neurologic morbidities, require careful consideration and discussion with parents.
• The study highlights the critical need to weigh the benefits against the risks of extended ECMO in pediatric patients.