Large Single-Center Experience With Extubation During Neonatal and Pediatric Extracorporeal Membrane Oxygenation

Area of Science:

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

Background:

• Extubation in neonatal and pediatric patients on extracorporeal membrane oxygenation (ECMO) may prevent ventilator-induced lung injury, reduce sedative exposure, and enhance recovery.
• Limited data exists on the feasibility and safety of extubation while on ECMO in pediatric populations.

Purpose of the Study:

• To describe the single-center experience with extubating patients on ECMO.
• To evaluate the outcomes and complications associated with extubation in this cohort.

Main Methods:

• Retrospective cohort study of patients undergoing ECMO from 2013 to 2022.
• Analysis of extubated versus non-extubated ECMO patients across cardiac, pediatric, and neonatal intensive care units.
• Comparison of survival rates and complication profiles.

Main Results:

• 40 patients (8.6% of ECMO runs) were extubated on ECMO, representing the largest single-center pediatric cohort.
• Extubated patients were older, received pulmonary support, and had longer ECMO runs.
• Survival to discharge was 75% for extubated patients, significantly higher than the non-extubated group (p=0.044).
• Adjusted analysis showed increased gastrointestinal hemorrhage and continuous renal replacement therapy (CRRT) use in extubated patients, but no increase in other major complications.

Conclusions:

• Extubation on ECMO is a feasible and safe strategy in select pediatric patients.
• This practice is associated with improved survival to hospital discharge.
• While some complications like GI hemorrhage and CRRT use were more frequent, overall major complications were not increased.