Incidence and Mortality Outcomes of Extracorporeal Membrane Oxygenation in Infants With Congenital Lung Malformations: A Registry Study

Congenital lung malformations (CLMs) are rare developmental anomalies that can cause severe respiratory failure in early infancy, occasionally necessitating extracorporeal membrane oxygenation (ECMO). This study aimed to determine the incidence of ECMO use and identify predictors of survival among infants with isolated CLMs who required ECMO support. We conducted a retrospective cohort study using the Extracorporeal Life Support Organization (ELSO) registry from 2000 to 2024. The primary outcome was survival to hospital discharge. Bivariate and multivariable logistic regression analyses were performed. Among 451 infants, overall survival was 47%. The majority were neonates (< 28 days, 88%). Survival varied by CLM subtype: congenital pulmonary airway malformation (CPAM, 67%), followed by congenital lobar emphysema (CLE, 50%) and other CLMs (42%) (p < 0.001). Higher weight at ECMO initiation was associated with survival (odds ratio [OR]: 1.39, 95% CI: 1.10-1.78), and so was use of postnatal corticosteroids (OR: 1.99, 95% confidence interval [CI]: 1.15-3.49). Extracorporeal cardiopulmonary resuscitation (ECPR), hemorrhagic complications, and neurologic complications were independently associated with higher mortality. Survival among infants with CLMs requiring ECMO varies by diagnosis subtype, weight, and clinical complications. These findings offer important insights into risk stratification and may inform clinical decision-making.