Extracorporeal membrane oxygenation outside the operating room in neonates and infants.

OBJECTIVE: Long-term outcomes of emergent extracorporeal membrane oxygenation (ECMO) initiated outside the operating room remain poorly defined. We evaluated long-term outcomes after emergent ECMO support outside the operating room in neonates and infants. METHODS: We retrospectively evaluated 59 neonates and infants requiring emergent ECMO support outside the operating room at our institution (2010-2024). The primary outcome was overall survival after ECMO support. Secondary outcomes included in-hospital outcomes, mortality risk factors, and the impact of manual cardiopulmonary resuscitation (CPR) duration at ECMO cannulation. RESULTS: Median age and body weight at emergent ECMO were 1.6 months and 3.2 kg, respectively. Indications for ECMO were reasons for emergent ECMO were extracorporeal cardiopulmonary resuscitation in 40 (68%) patients, cardiogenic shock in 12 (20%), septic shock in 1 (2%), and respiratory failure in 6 (10%). The median manual CPR duration was 36 minutes. A CPR duration exceeding 36 min was associated with cervical ECMO cannulation (p = 0.001) and hypoxic encephalopathy (p = 0.008). The median ECMO duration was 4 days. Forty-two (71%) patients were weaned from ECMO, and 32 (54%) survived to discharge. At a median follow-up of 3.7 years, overall survival after ECMO support was 57%, 47%, and 44% at 1, 3, and 5 years, respectively. Multivariable analysis detected non-cerebral bleeding (p = 0.049) and lack of catheter/surgical intervention (p = 0.004) as mortality risk factors. CONCLUSIONS: Long-term survival after emergent ECMO outside the operating room was acceptable in neonates and infants. Strategies to reduce bleeding complications and minimize resuscitation time may further improve outcomes.