Introduction: The decision to place a critically ill pediatric patient on extracorporeal membrane oxygenation (ECMO) can be challenging, as the process involves complex clinical variables as well as the mobilization of significant hospital and personnel resources. ECMO cannulation at night has been associated with worse outcomes in adult patients. There is a paucity of literature regarding time of ECMO cannulation and outcomes in pediatric patients. We sought to investigate the association between the time of ECMO cannulation and clinical outcomes in critically ill children in the pediatric intensive care unit (PICU). We hypothesized that children cannulated to ECMO during nighttime hours had worse clinical outcomes. Methods: We performed a retrospective review of 56 patients who required ECMO cannulation from January 2023 through June 2025 in a quaternary PICU. Patient demographics and clinical outcomes, including time of cannulation, duration of ECMO, survival (24 hours off ECMO and to hospital discharge), need for kidney replacement therapy were collected. Cohorts were divided into 2 groups based on the daytime (7A-M-7PM) and nighttime (7PM-7AM) for purposes of comparison. Results: Of 56 patients, 25 (45%) were cannulated during nighttime hours (male, 44%; median age 1.85 yr, median weight 14.7kg). Patients cannulated during nighttime hours had longer duration of ECMO (140 vs 123.8 hours, p< 0.01), had similar use of CKRT (47.6% vs 20.8%, p= 0.35), and had similar survival rate for 24 hours after decannulation (40% vs 58%, p=0.18). However, survival to hospital discharge (28% vs 52%, p< 0.05) was worse in those cannulated during nighttime hours. Conclusions: Children cannulated to ECMO during nighttime hours may require longer runs of ECMO and have worse overall survival rates. The complex decision making regarding the need for ECMO may need to include the system resources available, which are likely influenced by the time of day.
Schneider et al. (Sun,) studied this question.