Taylor M. Smith, Kathryn Restaino, Stuart Lipsitz, Jai Krishan Khurana, Mary P. Mullin, John N. Kheir, Katie M. Moynihan
Boston Children’s Hospital, Brigham and Women’s Hospital and Harvard Medical School.
United States
American Society of Artificial Internal Organs Journal
ASAIO J 2026;
DOI: 10.1097/MAT.0000000000002766
Abstract
Limited data describe children with pulmonary hypertension (PH) supported on extracorporeal membrane oxygenation (ECMO). This retrospective study (2017-2023), including children less than 18 years with PH at a quaternary institution, identified associations with 1) mortality in ECMO-supported patients, 2) extracorporeal cardiopulmonary resuscitation (ECPR), and 3) inpatient death without ECMO (DWE). Among 113 children with PH supported on ECMO, the median age was 31 days (interquartile range [IQR]: 1-332), mortality was 41%, with 19% requiring ECPR. Lung disease was the most common PH-subgroup (52%). In multivariable models including pre-cannulation factors, ECPR (adjusted odds ratios [aOR]: 4.9 [1.4-17.2]) and pulmonary vein stenosis (PVS) (aOR: 7.5 [1.1-51.4]) were associated with mortality. After adding post-cannulation factors, ECPR (aOR: 9.41 [2.21-40.12]), PVS (aOR: 8.07 [1.05-61.93]), and longer ECMO duration (aOR: 3.21 [1.41-9.90]) were independently associated with mortality. Extracorporeal cardiopulmonary resuscitation was associated with cardiac intensive care unit (CICU) admission (OR: 11.7 [3.2-42.5]), single-ventricle physiology (OR: 6.6 [2.3-18.5]), and left heart disease PH-subgroup (OR: 8.9 [3.1-25.6]). Compared to ECMO-supported patients, DWE patients (n = 75) were older and more likely to have a tracheostomy, had lower pulmonary artery pressures, received fewer PH medications, and differed in PH-subgroup. While ECPR and PVS confer increased mortality risk in children with PH requiring ECMO, survival remains achievable. Incorporating patient-level data into prognostic frameworks may support individualized approaches to ECMO decision-making in this cohort.
Category
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
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