Kevin L. Smith, David W. Liddle, Mary Sciff, K. T. Fishbein, Rod Ghassemzadeh, Brian Feingold, Laura J. Olivieri
Children’s National Medical Center. University of Pittsburgh Children’s Hospital of Pittsburgh and University of Pittsburgh.
United States
Pediatric Cardiology
Pediatr Cardiol 2026;
DOI: 10.1007/s00246-026-04245-9
Abstract
Venoarterial extracorporeal membrane oxygenation (VA ECMO) offers vital support to children with cardiopulmonary failure. Echocardiography is commonly used to assess readiness for decannulation, however pediatric data supporting utility is limited. This is a retrospective, single-center study analyzing echoes during pediatric VA ECMO clamp trials from 2012 ̶ 2024. Subjects were categorized as cardiomyopathy/myocarditis (CM), persistent pulmonary hypertension of the newborn (PPHN), or congenital heart disease (CHD). Subjects were grouped as those who did (+ decan) and did not (− decan) tolerate decannulation within 24 h of the trial. 103 subjects (median age 9.1 days (3.7–109.5 days), 39% female), underwent 173 unique clamp trial echoes. 49.1% (n = 85) of patients were decannulated within 24 h of first clamp trial. In the PPHN group each 1 m/s increase in tricuspid regurgitation peak velocity was associated with 73% lower odds of +decan (OR = 0.27, CI: 0.09–0.79, p = 0.02), and > mild atrioventricular valve regurgitation was associated with 84% lower odds of having + decan (OR = 0.16, CI: 0.04–0.69, p = 0.01). In the CM group, each 5% decrease in left ventricular ejection fraction was associated with 29% lower odds of having + decan (OR = 0.71, CI: 0.53–0.95, p = 0.02). No echo associations with decannulation outcome were found in the CHD group. Predictors of a well-tolerated ECMO decannulation include lower tricuspid regurgitation peak velocity and < mild atrioventricular valve regurgitation in PPHN and higher left ventricular ejection fraction in CM. Because CHD was split into single and two ventricle groups, the resulting small sample size limited evaluation for CHD patients, which deserves further study.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
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