Related Experiment Video
Updated: Aug 16, 2026
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Pediatric extracorporeal membrane oxygenation support at a single center: Outcomes by indication, prognostic factors,
L Lily Rosenthal1,2,3, Andreas W Flemmer4, Kai Martin Förster4
1Division for Pediatric and Congenital Heart Surgery, LMU University Hospital Munich, Germany.
Insights
Elevated lactate levels before and after pediatric extracorporeal membrane oxygenation (pECMO) independently predict mortality. Lactate is a valuable prognostic biomarker for children requiring pECMO support.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary support technologies
- Biomarker research
Background:
- Pediatric extracorporeal membrane oxygenation (pECMO) is a vital treatment for severe pediatric cardiac or respiratory failure.
- Identifying prognostic factors is crucial for improving risk stratification and clinical decision-making in pECMO patients.
Purpose of the Study:
- To identify independent predictors of mortality in pediatric patients undergoing pECMO.
- To evaluate the prognostic value of lactate levels in this patient population.
Main Methods:
- Retrospective review of 149 pediatric patients (<18 years) who received pECMO.
- Data collection included demographics, clinical information, laboratory results, and outcomes.
- Primary endpoint was 30-day survival; multivariable Cox regression analysis was used.
Main Results:
- Indications for pECMO included cardiac failure (56%), respiratory failure (37%), and extracorporeal cardiopulmonary resuscitation (ECPR; 11%).
- Pre-pECMO lactate (HR 1.042) and post-pECMO lactate (HR 1.067) were independent predictors of mortality.
- Pre- and post-pECMO aspartate aminotransferase and pH were not significantly associated with mortality.
Conclusions:
- Elevated lactate levels before and after pECMO initiation are independent predictors of mortality.
- Lactate can serve as a valuable biomarker for prognostication and risk stratification in pediatric ECMO patients.
Background:
Pediatric extracorporeal membrane oxygenation (pECMO) provides life-saving cardiopulmonary support for children with severe cardiac or respiratory failure. Identifying prognostic factors may improve risk stratification and clinical decision-making.
Methods:
We retrospectively reviewed 149 patients (<18 years) who received pECMO at a single center between 2003 and 2025. Patients with multiple extracorporeal membrane oxygenation (ECMO) runs during the same hospitalization were excluded. Demographic, clinical, laboratory, and outcome data were collected. The primary endpoint was 30-day survival.
Results:
Among 149 patients, the median age was 245 days, and the median weight was 6.3 kg. Indications for ECMO were acute cardiac failure (56%), respiratory failure (37%), and extracorporeal cardiopulmonary resuscitation (ECPR; 11%). Kaplan-Meier analysis demonstrated significant survival differences among groups (log-rank P = 0.010). Mean survival times were 24.07 days (95% confidence interval [CI] 20.72-27.41) for cardiac failure, 28.99 days (95% CI 24.64-33.35) for respiratory failure, and 14.13 days (95% CI 7.72-20.55) for ECPR. In multivariable Cox regression analysis, pre-ECMO lactate (hazard ratio [HR] 1.042, 95% CI 1.008-1.078; P = 0.017) and post-ECMO lactate (HR 1.067, 95% CI 1.024-1.110; P = 0.002) were independent predictors of mortality. Pre- and post-ECMO aspartate aminotransferase and pH were not significantly associated with mortality.
Conclusions:
Elevated lactate levels before and after ECMO initiation independently predicted mortality in pediatric patients receiving ECMO. Lactate may serve as a useful biomarker for prognostication and risk stratification in this population.
Related Concept Videos
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:29Mechanical Ventilation I: Indication and Settings