Evaluation of extracorporeal membrane oxygenation in children with acute hypoxemic respiratory failure and hemodynamic instability in China: a 7-year single-center retrospective study.

Authors

Jiayun Ying, Xiaodi Cai, Gangfeng Yan, Ye Cheng, Weiming Chen, Guoping Lu

Published in

Frontiers in medicine. Volume 13. Pages 1867681. Epub Jun 24, 2026.

Abstract

To characterize the clinical features, laboratory parameters, and outcomes of pediatric patients with acute hypoxemic respiratory failure (AHRF) and concurrent hemodynamic instability requiring extracorporeal membrane oxygenation (ECMO), and to identify risk factors associated with mortality.
This retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) of the Children's Hospital of Fudan University, China. We enrolled patients aged 28 days-18 years with AHRF and hemodynamic instability despite mechanical ventilation who received ECMO support between January 2015 and December 2021. The primary outcome was 28-day in-hospital mortality. Data including demographics, comorbidities, laboratory findings, ventilator settings, and rescue therapies were analyzed. Multivariable logistic regression analysis was used to identify independent risk factors for survival. Receiver operating characteristic (ROC) curves and Kaplan-Meier survival curves were subsequently constructed to evaluate the predictive performance and compare cumulative survival rates, respectively.
Out of 57 eligible patients, 52 (91.2%) were included in the final analysis. The overall mortality rate was 53.8%. Successful weaning, achieved in 34 patients, correlated strongly with improved survival (p < 0.001). Before ECMO initiation, survivors had significantly higher PaO₂ (median: 64.4 vs. 60.5 mmHg, p = 0.011) and P/F ratio (75.9 vs. 61.8, p = 0.007) than non-survivors. The P/F ratio emerged as a significant predictor of survival on ROC analysis, yielding an AUC of 0.766 (95% CI: 0.629 and an optimal cut-off 77.9.
For pediatric patients with severe AHRF and hemodynamic compromise placed on VA-ECMO, lower pre-ECMO PaO₂ and P/F ratio were associated with poor prognosis.

PMID:
42422825
Bibliographic data and abstract were imported from PubMed on 09 Jul 2026.

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