Neonatal ECMO outcomes in transported versus in-house patients: A single-center study

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for neonates with severe respiratory or circulatory failure. Due to its complexity, ECMO is often performed in specialized centers, necessitating the transport of eligible patients from non-ECMO centers. While ECMO transport has been deemed safe, limited data exist comparing outcomes between in-house and transported neonates. This study aimed to evaluate the survival and long-term outcomes of neonates requiring ECMO support based on the cannulation location.

Methods

A single-center study was conducted at the largest tertiary center in Israel (2009-2025). Patients were categorized based on cannulation site: in-house ECMO (performed at the tertiary center) or on-site ECMO (cannulated at the referring center and transported on ECMO support). Primary endpoints were in-hospital and long-term survival. Secondary outcomes included ECMO-related complications and long-term sequelae.

Results

A total of 53 neonates received ECMO support, with 26 (49.1%) in the in-house group and 27 (50.9%) in the on-site group. Despite pre-cannulation differences, including higher vasoactive-inotropic scores in the in-house group, lower pH and higher pCO2 in the on-site group, there were no statistically significant differences between the groups (53.8% vs 77.8%, p = 0.12). ECMO-related adverse events and long-term sequelae showed no statistically significant differences between groups, though the study was underpowered to detect clinically meaningful differences.

Conclusion

Although survival rates of critically ill neonates requiring on-site ECMO initiation and transport and those connected to ECMO in the in-house setting, did not differ significantly, the study was underpowered to detect potentially meaningful differences. Nonetheless, the findings reinforce the viability of neonatal ECMO transport.