505 - Pediatric and Neonatal Extra Corporeal Membrane Oxygenation (ECMO) Outcomes in Hawaii

Publication Number: 505.5594

Sayaka M. Brown, Kapi'olani Medical Center for Women and Children, Honolulu, HI, United States; Andrea Siu, Hawaii Pacific Health, Honolulu, HI, United States; Sheree Kuo, University of Hawaii, Honolulu, HI, United States; Len Y. Tanaka, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Prashant J. Purohit, University of Hawaii, John A. Burns School of Medicine, honolulu, HI, United States

Background: Pediatric and neonatal ECMO outcomes are associated with many factors, including the underlying disease process, patient demographics, the threshold for ECMO initiation, patient severity, and the number of cases managed by the center. Our low-case volume center utilizes ECMO consultation, early referral, and a heads-up system to optimize the outcomes.

Objective: We analyzed the outcomes and the factors affecting the outcomes of pediatric and neonatal ECMO patients in Hawaii.

Design/Methods: This is a single-center, retrospective study examining all neonatal and pediatric patients treated with ECMO from January 2009 to June 2023. The variables collected included patient demographics, diagnosis, severity scoring, hospital length of stay (LOS), intensive care unit (ICU) LOS, mechanical ventilation duration, transfer, and survival. Mann-Whitney U test, Fisher’s exact test, and logistic regression analysis were applied using Stata 15.1.

Results: Eighty-six patients were treated with ECMO from January 2009 to June 2023. This entire cohort's survival rate to discharge was 65.12% (Figure 1). Excluding eight patients who required transfers to the higher centers, 49 of 78 patients survived to discharge (62.82%). Comparisons between survivors and non-survivors are presented in Tables 1 and 2. Young patient age, diagnosis of meconium aspiration syndrome, and inhaled nitric oxide use before ECMO were associated with improved survival. Whereas the need for extracorporeal cardiopulmonary resuscitation (ECPR) and dialysis (Figure 2) were associated with poorer survival rates, as verified by logistic regression and Kaplan Meier survival analysis. There was no difference between the two groups in arterial blood gas parameters, lactate level, vasoactive inotropic score, ECMO flow, ECMO type, ECMO cannulation site, or presence of multiple organ failure.

Conclusion(s): The survival rate to discharge following pediatric and neonatal ECMO at our low-case volume center is comparable to that of high-case volume centers worldwide in the published literature. We propose that a robust training program, early ECMO referral, and a heads-up system at our center helped conquer the weakness of low-case volume centers. Our study also suggested that an early initiation of ECMO before cardiac arrest, avoiding ECPR, improving renal perfusion with ECMO, and avoiding dialysis can help improve outcomes.

Figure 1: ECMO Outcomes
ECMO.PAS.Figure1.pdfThe ECMO outcomes related to survival and transfer are shown in Figure 1.

Table 1: ECMO Patient Demographics and Diagnoses. Table 2: Comorbidities
ECMO.PAS.Tables.2025.pdfBaseline characteristics of the survivors and non-survivors are outlined in Table 1.
Comorbidities and severity indices are compared in Table 2.

Figure 2: Kaplan Meier Survival analysis based on dialysis requirement
ECMO.Dialysis.PAS.2025.pdfThe Kaplan-Meier survival analysis showed a poor survival rate for patients requiring dialysis.

Figure 1: ECMO Outcomes
ECMO.PAS.Figure1.pdfThe ECMO outcomes related to survival and transfer are shown in Figure 1.

Table 1: ECMO Patient Demographics and Diagnoses. Table 2: Comorbidities
ECMO.PAS.Tables.2025.pdfBaseline characteristics of the survivors and non-survivors are outlined in Table 1.
Comorbidities and severity indices are compared in Table 2.

Figure 2: Kaplan Meier Survival analysis based on dialysis requirement
ECMO.Dialysis.PAS.2025.pdfThe Kaplan-Meier survival analysis showed a poor survival rate for patients requiring dialysis.