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Is Veno-Venous Extracorporeal Membrane Oxygenation Always the Right Choice for Pediatric Patients With Refractory

Jana Assy1, Guner Yit2, Danilo Alunni Fegatelli3

  • 1From the Department of Pediatrics, University Hospital of Liège, Belgium.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|January 23, 2026
PubMed

Insights

Converting pediatric patients on veno-venous extracorporeal membrane oxygenation (VV ECMO) to other configurations increases mortality and complications. Careful initial ECMO mode selection is crucial for better survival in refractory respiratory failure.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiopulmonary Support
  • Extracorporeal Membrane Oxygenation

Background:

  • Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) use for pediatric refractory respiratory failure has risen.
  • Conversion to other ECMO configurations is sometimes necessary for cardiac dysfunction or persistent gas exchange issues.

Purpose of the Study:

  • To evaluate the incidence, outcomes, and predictive factors for converting pediatric patients from VV ECMO to alternative configurations.
  • To identify factors associated with increased mortality and complications after VV ECMO conversion.

Main Methods:

  • Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) Registry.
  • Included 5,162 pediatric patients receiving VV ECMO between 2014 and 2024.
  • Compared outcomes between patients converted to veno-arterial (VA) or other ECMO configurations and those remaining on VV ECMO.

Main Results:

  • 8.1% (421/5,162) of pediatric VV ECMO patients were converted.
  • The conversion group had significantly higher in-hospital mortality (51.1% vs. 26.7%) and more complications.
  • Conversion was associated with longer ECMO support (13 vs. 8 days) and hospital stay (39 vs. 32 days).
  • Higher pre-ECMO lactate levels predicted a higher risk of conversion.

Conclusions:

  • VV ECMO conversion in pediatric refractory respiratory failure is associated with worse outcomes.
  • Appropriate initial ECMO configuration selection may improve survival.
  • Avoid VV ECMO in patients with low mean arterial pressure and high lactate levels pre-ECMO.

Keywords:
ELSO registryconfiguration changeconversionhybrid configurationveno-venous ECMO

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