Clinical Profile and Neurological Outcomes of Pediatric Patients Supported on Venoarterial Extracorporeal Mechanical Oxygenation in a Cardiorespiratory Pediatric Intensive Care Unit: A Single-Center Study.

Extracorporeal membrane oxygenation (ECMO) has become a standard therapy in extremely sick patients for various indications. This rising use of ECMO warrants careful consideration of its neurological effects. Our single-center retrospective study, conducted between January 2016 and December 2022, on children ≤16 years, aimed to identify clinical and biochemical parameters associated with adverse neurological complications (ANC) on venoarterial ECMO (VA-ECMO), and its impact on their morbidity and mortality. Of 91 VA-ECMO runs analyzed, 37% were extracorporeal cardiopulmonary resuscitation (ECPR) recipients. Adverse neurological complications were diagnosed in 26% of patients during their ECMO run, and in 21% post-decannulation, for a total of 47% of the cohort. Overall, neck cannulation ( p = 0.049), lower pre-ECMO pH ( p = 0.018), higher pre-ECMO lactate ( p < 0.001), delayed lactate clearance ( p = 0.002), and progressive multiorgan dysfunction ( p = 0.018) was associated with ANC. The absence of ANC conferred better survival to decannulation and quality of function status. Sub-analysis on ECPR recipients noted that longer time to cannulation ( p = 0.023), lower pre-ECMO pH ( p = 0.006), higher pre-ECMO lactate ( p = 0.006), and delayed lactate clearance ( p = 0.024) had higher ANC. At hospital discharge, 78.6% of survivors, including 91% of ECPR survivors had favorable neurological outcomes. Point-of-care testing combined with standard neuromonitoring may help identify and prognosticate ECMO recipients.