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Prostaglandin Administration and Outcomes in Children on Extracorporeal Membrane Oxygenation

Weidi Xiao1, Nedaa Aldairi2, Brian S Marcus3

  • 1School of Public Health, Yale, New Haven, CT, USA.

World Journal for Pediatric & Congenital Heart Surgery
|June 29, 2026
PubMed

Insights

Prostaglandins PGE1 and PGI2 did not reduce bleeding or clotting risks in pediatric ECMO patients. This study found no protective effect against severe hemorrhage or thrombotic events in over 22,000 children on ECMO.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiovascular Research
  • Pharmacology

Background:

  • Extracorporeal Membrane Oxygenation (ECMO) carries significant risks of bleeding and clotting.
  • Traditional anticoagulants (heparin, bivalirudin) target coagulation, but prostaglandins (PGE1, PGI2) are explored for adjunctive platelet inhibition.
  • The role of prostaglandins in mitigating ECMO-related complications remains unclear.

Purpose of the Study:

  • To evaluate the association between prostaglandin (PGE1, PGI2) use and the risk of severe bleeding or clotting events in pediatric ECMO patients.
  • To determine if prostaglandins offer adjunctive benefits beyond standard anticoagulation in this population.
  • To analyze the impact of prostaglandins on specific severe outcomes like pulmonary and intracranial hemorrhage, and stroke.

Main Methods:

  • Retrospective analysis of the Pediatric Health Information System database (2004-2025).
  • Inclusion of pediatric patients supported with ECMO.
  • Generalized linear mixed model regressions were used to assess outcomes, adjusting for relevant covariates including pulmonary hypertension.

Main Results:

  • A total of 22,061 pediatric ECMO patients were analyzed.
  • PGE1 and PGI2 were independently associated with an increased risk of pulmonary hemorrhage (aOR 1.24, P=.003 for PGE1; aOR 1.21, P=.047 for PGI2).
  • Neither PGE1 nor PGI2 showed an independent association with intracranial hemorrhage, stroke, or other major bleeding/thrombotic events.

Conclusions:

  • In a large cohort of pediatric ECMO patients, prostaglandin E1 (PGE1) and prostacyclin (PGI2) use were linked to a higher risk of pulmonary hemorrhage.
  • These prostaglandins did not confer measurable protection against other major bleeding or clotting complications during ECMO support.
  • Findings suggest prostaglandins may not be beneficial for preventing severe bleeding or clotting in pediatric ECMO, and may increase pulmonary hemorrhage risk.

Keywords:
alprostadilanticoagulantschildepoprostenolextracorporeal membrane oxygenationprostaglandins

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