Application of extracorporeal membrane oxygenation in respiratory and circulatory support of preterm infants: a multicenter retrospective study in China.

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) serves as a vital rescue therapy for neonates with refractory cardiopulmonary failure, yet domestic clinical data regarding ECMO use in preterm infants remain scarce. This study sought to summarize clinical experiences and long-term prognostic outcomes of ECMO support among preterm infants in China. METHODS: We conducted a retrospective analysis of preterm infants receiving ECMO between January 2018 and November 2025 using data from the Pediatric Extracorporeal Life Support Alliance of China (PELSAC). The primary study outcomes were ECMO weaning success and survival to hospital discharge. Secondary outcomes included ECMO-associated complications, intracranial hemorrhage and hypoxic-ischemic brain injury detected by cranial imaging, and neurodevelopmental delay assessed at corrected age 18-24 months. Clinical outcomes were compared between infants with birth gestational age ≤34 weeks and those >34 weeks. RESULTS: Six out of 23 participating PELSAC centers (26.1%) implemented ECMO for 22 preterm infants, including 8 infants with gestational age ≤34 weeks and 14 infants over 34 weeks. The cohort had a median gestational age of 34 (32-36) weeks, a median birth weight of 2.5 (1.80-3.63) kg, and a median cannulation weight of 2.2 (1.80-2.70) kg. The median ECMO runtime was 112 (19-245) hours. 18 infants (81.8%) were successfully weaned, and 17 (77.3%) survived discharge. Complications were limited to one cannulation-site bleed and one thrombosis. Post-ECMO MRI detected brain injury in 9 of 17 survivors (52.9%), including 5 intracranial hemorrhages (29.4%) and 4 isolated hypoxic-ischemic lesions. At 18-24 months corrected age, 10 survivors (58.8%) had normal neurodevelopment, while 7 (41.2%) had developmental delay. Outcomes did not differ significantly between the ≤34-week and >34-week subgroups. CONCLUSION: ECMO in preterm infants (≥32 weeks' gestation, ≥1.8 kg) achieves a high survival rate, although neurological complications remain common and require close surveillance. These findings support the potential for wider clinical application of ECMO in carefully selected preterm infants.