Process Analysis of Neonatal and Pediatric Respiratory Extracorporeal Membrane Oxygenation Referrals: An 8-Year Experience at a High-Volume Center.

OBJECTIVES: To evaluate neonatal and pediatric extracorporeal membrane oxygenation (ECMO) referrals and transfers to a high-volume center and optimize the process of ECMO referrals and decision-making.

DESIGN: This retrospective study analyzed ECMO referrals, focusing on various patient parameters during the request, transport, use of ECMO, and outcome. Data were grouped into transferred and nontransferred neonates and children.

SETTING: This study analyzes ECMO referrals and transfers to the Clinic of Neonatology and Pediatric Intensive Care at an ECMO center between 2015 and 2023.

PATIENTS: A total of 348 neonatal and pediatric ECMO referrals were included in the analysis.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Neonates were transferred at a higher rate (79/189 patients, 41.8%) than pediatric patients (40/159 patients, 25.2%). The leading neonatal diagnoses (data available n = 164) were meconium aspiration syndrome (59/164 patients, 36%), congenital diaphragmatic hernia (35/164 patients, 21.3%), and persistent pulmonary hypertension (27/164 patients, 16.5%). In pediatric patients (data available n = 133), viral pneumonia was most common (61/133 patients, 45.9%). A significant association (Kruskal-Wallis test) was found between the Vasoactive-Inotropic Score (VIS) and ECMO initiation for transferred patients (p < 0.05), as well as a higher oxygenation index (OI, calculated immediately after the transfer) in ECMO groups of transferred patients (p < 0.001; t test). Most transfers (82/107 patients, 76.6%) were performed by helicopter. Neonatal ECMO survival was 90.2% (37/41 patients; vs. Extracorporeal Life Support Organization [ELSO] 69%); pediatric ECMO survival was 57.1% (4/7 patients; vs. ELSO 64%).

CONCLUSIONS: Structured referral processes, early telemedical contact, and standardized networks may improve ECMO outcomes and resource use. VIS and OI could be valuable tools for ECMO decision-making.