Hospital Survival After Neonatal and Pediatric Extracorporeal Membrane Oxygenation at a French Center: A Retrospective Cohort Study

Abstract

Abstract

Background: Outcomes after extracorporeal membrane oxygenation (ECMO) in children vary with indication, support mode, illness severity, and program context, while data from smaller programs remain limited. Methods: We conducted a retrospective single-center cohort study of all 30 unique neonatal and pediatric patients who commenced ECMO at CHRU de Tours from 20 March 2022 to 15 December 2025. The primary outcome was survival to hospital discharge. Continuous variables are reported as median [interquartile range], categorical variables as n/N (%), and key binary outcomes with exact 95% confidence intervals. Because only eight patients survived, the primary analysis was deliberately descriptive; no predictor model or broad unplanned hypothesis-testing panel was retained. Results: Fourteen patients were neonates and 16 were older children; median age was 4.3 months [0.1- 24.0] and median weight was 6.8 kg [3.0-12.0]. Twenty-seven patients received venoarterial ECMO, three received venovenous ECMO, and 10/29 with available data received extracorporeal cardiopulmonary resuscitation. Median annual volume was 7.5 cases (range, 6-9). Successful decannulation occurred in 9/30 patients (30.0%; 95% CI, 14.7%-49.4%), and 8/30 survived to hospital discharge (26.7%; 95% CI, 12.3%-45.9%). Fifteen patients had a recorded circuit change. Source- coded complication flags were frequent, including a field labeled disseminated intravascular coagulation in 25/30 patients; these fields had no prospective diagnostic criteria, timing, severity grading, or adjudication. Conclusion: This small, clinically heterogeneous and predominantly venoarterial cohort provides a local benchmark with substantial statistical uncertainty. The 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 complication counts should be interpreted as documentation signals rather than validated ECMO- attributable event rates. Three priorities for Tours are a prospective ELSO-aligned registry, structured review of every ECMO run and circuit event, and recurring competency-based simulation.