Is Veno-Venous Extracorporeal Membrane Oxygenation Always the Right Choice for Pediatric Patients With Refractory Respiratory Failure? An Extracorporeal Life Support Organization Registry analysis. - 2026
Is Veno-Venous Extracorporeal Membrane Oxygenation Always the Right Choice for Pediatric Patients With Refractory Respiratory Failure? An Extracorporeal Life Support Organization Registry analysis.
[en] Use of veno-venous (VV) extracorporeal membrane oxygenation (ECMO) to manage pediatric refractory respiratory failure has significantly increased in the last decade, however, when severe cardiac dysfunction develops or gas exchange remains impaired, conversion to other forms of bypass becomes essential. This retrospective study aims to evaluate the incidence, outcomes, and predictive factors for VV ECMO conversion in pediatric patients with refractory respiratory failure. Among the 5,162 pediatric patients in the Extracorporeal Life Support Organization (ELSO) Registry received VV ECMO between 2014 and 2024; among these, 421 (8.1%) were converted to veno-arterial (VA) or alternative configurations. The conversion group reported significantly higher in-hospital mortality (51.1% vs. 26.7%, p < 0.001) and higher incidence of complications during ECMO. Both the duration of ECMO support (13 [interquartile range {IQR}: 5; 27] vs. 8 [IQR: 4; 15] days; p < 0.001) and the duration of hospital stay (39 [18-73] vs. 32 [17-57] days, p = 0.007) were significantly longer in the conversion group. Higher levels of pre-ECMO lactate (odds ratio [OR]: 1.056 [95% confidence interval {CI}: 0.999-1.112], p < 0.042) were associated with a higher risk of conversion. This study suggests that the correct selection of the ECMO mode may improve survival and that VV ECMO should not be considered in patients presenting before ECMO deployment both low mean arterial pressure and high lactate levels.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Assy, Jana ; Université de Liège - ULiège > Département des sciences cliniques > Médecine générale
Yit, Guner; Department of Pediatric Surgery, Children's Hospital of Orange County and University of California Irvine, Orange, California
Alunni Fegatelli, Danilo; Department of Life Sciences, Health and Health Professions, Link Campus University, Rome, Italy
Giordano, Giovanni; Department of General, Specialistic Surgery and Anesthesiology, "Sapienza" University of Rome, Italy ; Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, Rome, Italy
Zullino, Veronica; Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, Rome, Italy
Tosi, Antonella; Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, Rome, Italy
Broman, Lars Mikael; ECMO Center Karolinska, Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden ; Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
Swol, Justyna; Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany ; Cardiac Surgery and Extracorporeal Life Support, Department of Cardio-Thoracic Surgery, ECLS Program, Heart & Vascular Centre MUMC+, Cardiovascular Research Institute Maastricht (CARIM
Levy, Yaël; Service de Médecine Intensive-Réanimation Pédiatrique et Cardio-Congénitale, CHU La Réunion Université Réunion, Saint-Denis, La Réunion
Pugliese, Francesco; Department of General, Specialistic Surgery and Anesthesiology, "Sapienza" University of Rome, Italy ; Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, Rome, Italy
Di Nardo, Matteo ; Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
Alessandri, Francesco ; Department of General, Specialistic Surgery and Anesthesiology, "Sapienza" University of Rome, Italy
Language :
English
Title :
Is Veno-Venous Extracorporeal Membrane Oxygenation Always the Right Choice for Pediatric Patients With Refractory Respiratory Failure? An Extracorporeal Life Support Organization Registry analysis.
Publication date :
23 January 2026
Journal title :
ASAIO Journal
ISSN :
1058-2916
eISSN :
1538-943X
Publisher :
Ovid Technologies (Wolters Kluwer Health), United States
1. FallonBPGadepalliSKHirschlRB: Pediatric and neonatal extracorporeal life support: Current state and continuing evolution. Pediatr Surg Int 37: 17–35, 2021.
2. SpeggiorinSRobinsonSGHarveyCet al. : Experience with the Avalon® bicaval double-lumen veno-venous cannula for neonatal respiratory ECMO. Perfusion 30: 250–254, 2015.
3. LillieJBootLSpeggiorinSNymanAG: Factors behind decline of venovenous extracorporeal membrane oxygenation to support neonatal respiratory failure. Pediatr Crit Care Med 21: e502–e504, 2020.
4. LillieJPienaarABuddJet al. : Multisite veno-venous cannulation for neonates and nonambulatory children. Pediatr Crit Care Med 22: 692–700, 2021.
5. KipfmuellerFBoBSchmittJet al. : Percutaneous, ultrasound-guided single- and multisite cannulation for veno-venous extracorporeal membrane oxygenation in neonates. Pediatr Pulmonol 58: 2574–2582, 2023.
6. KovlerMLGarciaAVBeckmanRMet al. : Conversion from venovenous to venoarterial extracorporeal membrane oxygenation is associated with increased mortality in children. J Surg Res 244: 389–394, 2019.
7. ConradSABromanLMTacconeFSet al. : The extracorporeal life support organization Maastricht treaty for nomenclature in extracorporeal life support. A Position Paper of the Extracorporeal Life Support Organization. Am J Respir Crit Care Med 198: 447–451, 2018.
8. Extracorporeal Life Support Organization: ECLS Registry Database Definitions and Forms.Available at: https://www.elso.org/registry/datadefinitions, forms, instructions.aspx. Accessed 25 July 2025.
9. TopjianAARaymondTTAtkinsDet al. ; Pediatric Basic and Advanced Life Support Collaborators: Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 142: S469–S523, 2020.
10. Extracorporeal Life Support Organization: ELSO International Summary of Statistics.Available at: www.elso.org/registry/internationalsummaryandreports.aspx. Accessed 25 July 2025.
11. CombesASchmidtMHodgsonCLet al. : Extracorporeal life support for adults with acute respiratory distress syndrome. Intensive Care Med 46: 2464–2476, 2020.
12. MoscatelliAFebboFBurattiSet al. : Intensivists performed percutaneous bicaval double-lumen echo-guided extracorporeal membrane oxygenation cannulation at bedside in newborns and children: A retrospective analysis. Pediatr Crit Care Med 20: 551–559, 2019.
13. SobolicMParkYGowdaSHet al. ; CHNC ECMO Focus Group: Early use experience of the crescent right atrial cannula for neonatal veno-venous extracorporeal membrane oxygenation. ASAIO J 71: 660–666, 2025.
14. WalczakABBigelowAMSchneiderBet al. : Experience with the crescent• right atrial jugular dual lumen catheter for pediatric venovenous extracorporeal membrane oxygenation: A case series. ASAIO J 69: e526–e530, 2023.
15. JaberBBembeaMMLoftisLLet al. ; the Pediatric ECMO (PediECMO) Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Extracorporeal Life Support Organization (ELSO): Venovenous versus venoarterial extracorporeal membranous oxygenation in inotrope dependent pediatric patients with respiratory failure. ASAIO J 67: 457–462, 2021.
17. RobertsNWestropeCPooboniSKet al. : Venovenous extracorporeal membrane oxygenation for respiratory failure in inotrope dependent neonates. ASAIO J 49: 568–571, 2003.
18. AgarwalPNatarajanGSullivanKet al. ; Children’s Hospital Neonatal Consortium (CHNC) ECMO and HIE Focus Groups: Venovenous versus venoarterial extracorporeal membrane oxygenation among infants with hypoxic-ischemic encephalopathy: Is there a difference in outcome? J Perinatol 41: 1916–1923, 2021.
19. ChoiBHVermaSCicaleseEet al. : Morbidity of conversion from venovenous to venoarterial ECMO in neonates with meconium aspiration or persistent pulmonary hypertension. J Pediatr Surg 56: 459–464, 2021.
20. Di NardoMAhmadAHMerliPet al. : Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: An international and multidisciplinary consensus statement. Lancet Child Adolesc Health 6: 116–128, 2022.
21. FalkLFletcher-SandersjööAHultmanJBromanLM: Conversion from venovenous to venoarterial extracorporeal membrane oxygenation in adults. Membranes (Basel) 11: 188, 2021.
22. SuwalskiPStaromłyńskiJBrączkowskiJet al. : Transition from simple V-V to V-A and hybrid ECMO configurations in COVID-19 ARDS. Membranes (Basel) 11: 434, 2021.
