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<p>Venoarterial extracorporeal membrane oxygenation (VA ECMO) offers vital support to children with cardiopulmonary failure. Echocardiography is commonly used to assess readiness for decannulation, however pediatric data supporting utility is limited. This is a retrospective, single-center study analyzing echoes during pediatric VA ECMO clamp trials from 2012 ̶ 2024. Subjects were categorized as cardiomyopathy/myocarditis (CM), persistent pulmonary hypertension of the newborn (PPHN), or congenital heart disease (CHD). Subjects were grouped as those who did (+ decan) and did not (− decan) tolerate decannulation within 24&#xa0;h of the trial. 103 subjects (median age 9.1 days (3.7–109.5 days), 39% female), underwent 173 unique clamp trial echoes. 49.1% (<i>n</i> = 85) of patients were decannulated within 24&#xa0;h of first clamp trial. In the PPHN group each 1&#xa0;m/s increase in tricuspid regurgitation peak velocity was associated with 73% lower odds of +decan (OR = 0.27, CI: 0.09–0.79, <i>p</i> = 0.02), and &gt; mild atrioventricular valve regurgitation was associated with 84% lower odds of having + decan (OR = 0.16, CI: 0.04–0.69, <i>p</i> = 0.01). In the CM group, each 5% decrease in left ventricular ejection fraction was associated with 29% lower odds of having + decan (OR = 0.71, CI: 0.53–0.95, <i>p</i> = 0.02). No echo associations with decannulation outcome were found in the CHD group. Predictors of a well-tolerated ECMO decannulation include lower tricuspid regurgitation peak velocity and &lt; mild atrioventricular valve regurgitation in PPHN and higher left ventricular ejection fraction in CM. Because CHD was split into single and two ventricle groups, the resulting small sample size limited evaluation for CHD patients, which deserves further study.</p>

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Utility of Echocardiography in 173 VA ECMO Clamp Trials in Babies and Children

  • 期刊论文

  • 发表日期：

    2026年4月2日

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  • Kevin L. Smith,
  • David W. Liddle,
  • Mary Schiff,
  • K. T. Fishbein,
  • Rod Ghassemzadeh,
  • Brian Feingold,
  • Laura J. Olivieri

摘要

Venoarterial extracorporeal membrane oxygenation (VA ECMO) offers vital support to children with cardiopulmonary failure. Echocardiography is commonly used to assess readiness for decannulation, however pediatric data supporting utility is limited. This is a retrospective, single-center study analyzing echoes during pediatric VA ECMO clamp trials from 2012 ̶ 2024. Subjects were categorized as cardiomyopathy/myocarditis (CM), persistent pulmonary hypertension of the newborn (PPHN), or congenital heart disease (CHD). Subjects were grouped as those who did (+ decan) and did not (− decan) tolerate decannulation within 24 h of the trial. 103 subjects (median age 9.1 days (3.7–109.5 days), 39% female), underwent 173 unique clamp trial echoes. 49.1% (n = 85) of patients were decannulated within 24 h of first clamp trial. In the PPHN group each 1 m/s increase in tricuspid regurgitation peak velocity was associated with 73% lower odds of +decan (OR = 0.27, CI: 0.09–0.79, p = 0.02), and > mild atrioventricular valve regurgitation was associated with 84% lower odds of having + decan (OR = 0.16, CI: 0.04–0.69, p = 0.01). In the CM group, each 5% decrease in left ventricular ejection fraction was associated with 29% lower odds of having + decan (OR = 0.71, CI: 0.53–0.95, p = 0.02). No echo associations with decannulation outcome were found in the CHD group. Predictors of a well-tolerated ECMO decannulation include lower tricuspid regurgitation peak velocity and < mild atrioventricular valve regurgitation in PPHN and higher left ventricular ejection fraction in CM. Because CHD was split into single and two ventricle groups, the resulting small sample size limited evaluation for CHD patients, which deserves further study.