Local Extracorporeal Membrane Oxygenation: Seven-Year Outcomes and Experience Developing a Low-Volume Pediatric Extracorporeal Membrane Oxygenation Program

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is traditionally concentrated at large tertiary pediatric centers. Geographic barriers to these centers may cause dangerous delays in cannulation, overburden regional hubs, and impose significant social and economic costs on families. Low-volume pediatric ECMO programs may mitigate these harms, but their feasibility and outcomes remain incompletely characterized. METHODS: We performed a single-center retrospective review of all pediatric and neonatal patients cannulated for ECMO between 2017 and 2024. The primary outcome was survival to hospital discharge or transfer. Results were contextualized against contemporaneous Extracorporeal Life Support Organization registry data. RESULTS: Thirty-eight patients underwent ECMO support (18 neonates, 20 pediatric patients including 2 extracorporeal cardiopulmonary resuscitation). Overall survival to discharge or transfer was 71% (27/38). Survival by subgroup showed neonatal cardiac 82%, pediatric cardiac 67%, neonatal pulmonary 71%, and pediatric pulmonary 56%. Both extracorporeal cardiopulmonary resuscitation patients survived. Outcomes were within range of contemporaneous Extracorporeal Life Support Organization registry benchmarks across most subgroups. CONCLUSIONS: With deliberate patient selection and structured programmatic processes, summarized in our Engagement, Competency, Mobilization, and Optimization (ECMO) framework, a low-volume pediatric ECMO program can achieve outcomes within range of national benchmarks whereas improving regional access and reducing family burden.