Extracorporeal membrane oxygenation outside the operating room in neonates and infants

Long-term outcomes of emergent extracorporeal membrane oxygenation (ECMO) initiated outside the operating room remain poorly defined. We evaluated long-term outcomes after emergent ECMO support outside the operating room in neonates and infants.

We retrospectively evaluated 59 neonates and infants requiring emergent ECMO support outside the operating room at our institution (2010-2024). The primary outcome was overall survival after ECMO support. Secondary outcomes included in-hospital outcomes, mortality risk factors, and the impact of manual cardiopulmonary resuscitation (CPR) duration at ECMO cannulation.

Median age and body weight at emergent ECMO were 1.6 months and 3.2 kg, respectively. Indications for ECMO were reasons for emergent ECMO were extracorporeal cardiopulmonary resuscitation in 40 (68%) patients, cardiogenic shock in 12 (20%), septic shock in 1 (2%), and respiratory failure in 6 (10%). The median manual CPR duration was 36 minutes. A CPR duration exceeding 36 min was associated with cervical ECMO cannulation (p = 0.001) and hypoxic encephalopathy (p = 0.008). The median ECMO duration was 4 days. Forty-two (71%) patients were weaned from ECMO, and 32 (54%) survived to discharge. At a median follow-up of 3.7 years, overall survival after ECMO support was 57%, 47%, and 44% at 1, 3, and 5 years, respectively. Multivariable analysis detected non-cerebral bleeding (p = 0.049) and lack of catheter/surgical intervention (p = 0.004) as mortality risk factors.

Long-term survival after emergent ECMO outside the operating room was acceptable in neonates and infants. Strategies to reduce bleeding complications and minimize resuscitation time may further improve outcomes.