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Updated: Nov 1, 2025
Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Tracheostomy and long-term mechanical ventilation in children after veno-venous extracorporeal membrane oxygenation
Palen P Mallory1, Ryan P Barbaro2,3, Melania M Bembea4
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.
Insights
About 14% of pediatric survivors of veno-venous extracorporeal membrane oxygenation (ECMO) required tracheostomy, and 9% needed long-term mechanical ventilation. These findings aid families needing prolonged respiratory support.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Medical Device Technology
Background:
- Acute respiratory failure in children often necessitates extracorporeal membrane oxygenation (ECMO) support.
- Understanding outcomes such as tracheostomy and mechanical ventilation is crucial for patient care and family guidance.
Purpose of the Study:
- To determine the incidence of tracheostomy placement and new long-term mechanical ventilation requirements after veno-venous ECMO in children.
- To investigate associations between patient factors and these outcomes.
Main Methods:
- Retrospective multicenter cohort study of 202 children receiving veno-venous ECMO (2011-2016).
- Analysis of demographics, pre-ECMO, and ECMO clinical factors.
- Evaluation of tracheostomy placement and discharge on mechanical ventilation.
Main Results:
- 67% of patients survived to ICU discharge.
- 14% of survivors received a tracheostomy post-ECMO; 9% were discharged on mechanical ventilation.
- Tracheostomy and ventilation needs were not linked to pre-ECMO illness severity but were associated with older age and higher weight for tracheostomy, and longer ECMO duration for both outcomes.
Conclusions:
- The rates of tracheostomy (14%) and mechanical ventilation (9%) post-ECMO are significant patient-centered outcomes.
- Findings provide essential information for families of children requiring prolonged ECMO support.
- Establishes a basis for future research in pediatric respiratory failure management.
Objective:
Our objective is to characterize the incidence of tracheostomy placement and of new requirement for long-term mechanical ventilation after extracorporeal membrane oxygenation (ECMO) among children with acute respiratory failure. We examine whether an association exists between demographics, pre-ECMO and ECMO clinical factors, and the placement of a tracheostomy or need for long-term mechanical ventilation.
Methods:
A retrospective multicenter cohort study was conducted at 10 quaternary care pediatric academic centers, including children supported with veno-venous (V-V) ECMO from 2011 to 2016.
Results:
Among 202 patients, 136 (67%) survived to ICU discharge. All tracheostomies were placed after ECMO decannulation, in 22 patients, with 19 of those surviving to ICU discharge (14% of survivors). Twelve patients (9% of survivors) were discharged on long-term mechanical ventilation. Tracheostomy placement and discharge on home ventilation were not associated with pre-ECMO severity of illness or pre-existing chronic illness. Patients who received a tracheostomy were older and weighed more than patients who did not receive a tracheostomy, although this association did not exist among patients discharged on home ventilation. ECMO duration was longer in those who received a tracheostomy compared with those who did not, as well as for those discharged on home ventilation, compared to those who were not.
Conclusion:
The 14% rate for tracheostomy placement and 9% rate for discharge on long-term mechanical ventilation after V-V ECMO are important patient-centered findings. This study informs anticipatory guidance provided to families of patients requiring prolonged respiratory ECMO support, and lays the foundation for future research.
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