Pediatric extracorporeal membrane oxygenation support at a single center: Outcomes by indication, prognostic factors, and duration.

Abstract

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.