Outcomes and associated ethical considerations of long-run pediatric ECMO at a single center institution

PurposeSurvival of neonatal and pediatric patients undergoing extracorporeal membrane oxygenation (ECMO)21 days has not been well described. We hypothesized that patients would have poor survival and increased long-term complications.MethodsRetrospective, single center, review and case analysis. Tertiary-care university children's hospital including neonatal, pediatric and cardiac intensive care units. After institutional review board approval, the charts of all patients<18years of age undergoing ECMO for 21 continuous days were performed, and they were compared to comparative patients undergoing shorter runs. Overall survival, incidence of complications, and post-discharge recovery were recorded.ResultsOverall survival was 36% in patients undergoing21 days of ECMO (N=14). 5/8 patients with cardiopulmonary failure from acquired etiologies survived versus 0/6 patients with congenital anomalies. 1/5 survivors achieved complete recovery with no neurologic deficits. The remaining survivors suffer from multiple medical and neurodevelopmental morbidities.ConclusionECMO support for 21 days is associated with poor survival, particularly in neonates with congenital anomalies. Long-term outcomes for survivors ought to be carefully weighed and discussed with parents given the high incidence of neurologic morbidities in this population.