Multisite veno venous extracorporeal support in children below 5 kg, experience from a referral center

Refractory respiratory failure is one of the leading indications for extracorporeal membrane oxygenation (ECMO) in neonates and children. Despite strong arguments supporting the use of veno-venous ECMO (VV ECMO), the international ELSO registry still reports a higher rate of veno-arterial ECMO (VA ECMO) in such situations. We report our experience with multisite V-V ECMO in children weighing less than 5 kg.

We conducted a single-center retrospective study from January 2017 to December 2025. All patients weighing less than 5 kg who underwent multisite VV ECMO were included in the analysis.

During the study period, 52 patients weighing less than 5 kg underwent VV ECMO. Among these, 43 (83 %) received multisite VV ECMO. The median weight was 3.5 kg (2.9 - 4.3) and 12 patients (28 %) weighed less than 3 kg. Seventeen (39 %) patients were initially supported with VA ECMO and subsequently converted to VV ECMO. Percutaneous cannulation was performed using 21 femoral cannulas (48 %) and 17 jugular cannulas (39%). All vascular complications occurred during percutaneous femoral cannulation. Median blood flows on days 1, 3 and 7 were 106 ml/kg/min (92 - 117), 105 ml/kg/min (94 - 116) and 101 ml/kg/min (93 - 118), respectively. The median duration of ECMO support was 12 days (6 - 17). Twenty-six (60%) patients were successfully weaned from ECMO, and 25 were alive 6 months after ECMO support.

Multisite VV ECMO is an effective cannulation strategy in children weighing less than 5 kg with refractory respiratory failure.