P . Anton-Martin et al .: J Extra Corpor Technol 2025 , 57 , 2 – 8 7
Table 3 . Fully adjusted multivariable logistic regression to ascertain factors associated with survival to hospital discharge .
Predictor |
OR ( 95 % CI ) |
p-value |
LOS ( days ) |
1.03 ( 1.01 , 1.04 ) |
< 0.001 |
Ventilator type ( HFOV vs Conventional ) |
28.44 ( 3.52 , 229.58 ) |
< 0.001 |
Ventilator type ( Other vs Conventional ) |
0.08 ( 0 , 1.5 ) |
< 0.001 |
Absence of hemorrhagic complication |
3.51 ( 1.12 , 11.05 ) |
0.031 |
Absence of renal complication |
3.50 ( 1.15 , 10.63 ) |
0.027 |
CI : confidence interval , HFOV : High-frequency oscillatory ventilation , LOS : length of stay , OR : odds ratio .
The primary strength of this study is that it represents the largest and first report of pediatric cardiac patients with PH on ECMO including international multicenter data . Nonetheless , we acknowledge several limitations . It is a retrospective database review that depends on accurate data reporting from multiple ECMO centers worldwide . Center variation in the use of ECMO could not be accounted for . Additionally , while a statistically significant survival benefit was identified with the utilization of HFOV before ECMO cannulation in these patients , the power of this association is limited by the small number of patients who utilized HFOV compared to other ventilatory strategies . Furthermore , underlying differences in disease characteristics between patients on conventional modes vs HFOV , which are not fully captured in the ELSO registry , may have also contributed to these findings . Finally , we were not able to adjust for unreported factors associated with worse outcomes such as severity of illness scores , congenital heart surgery procedural scores , and unrecorded comorbidities .
In conclusion , in pediatric cardiac patients with acute pulmonary hemorrhage , the use of HFOV before ECMO cannulation is independently associated with improved survival . A prospective evaluation of mechanical ventilation practices preceding ECMO may enhance outcomes in this medically complex population .
Acknowledgements
The authors thank Meredith Ray , PhD from the Division of Epidemiology , Biostatistics , and Environmental Health at the University of Memphis , for the statistical support .
Funding This research did not receive any specific funding .
Conflicts of interest Authors declared no conflict of interest .
Data availability statement
The data are available from the corresponding author on request ( with permission from the ELSO ).
Author contribution statement
P . A . M ., H . S . designed this study . P . A . M . performed the research and analyzed the data . P . A . M ., C . Y ., S . V . wrote the manuscript , and all authors contributed to the final version .
Ethics approval
We utilized the Extracorporeal Life Support Organization ( ELSO ) registry database for this retrospective study . The Institutional Review
Board at the University of Tennessee Health Science Center reviewed the study and determined it to be Not Human Subjects Research status ( IRB No . 22-08818-NHSR ). References
1 . Godfrey S . Pulmonary hemorrhage / hemoptysis in children . Pediatr Pulmonol . 2004 ; 37:476 – 484 .
2 . Coss-Bu JA , Sachdeva RC , Bricker JT , Harrison GM , Jefferson LS . Hemoptysis : a 10-year retrospective study . Pediatrics . 1997 ; 100 : E7 .
3 . Baroutidou A , Arvanitaki A , Hatzidakis A , et al . Haemoptysis in pulmonary arterial hypertension associated with congenital heart disease : insights on pathophysiology , diagnosis and management . J Clin Med . 2022 ; 11:633 .
4 . Knoflach K , Rapp CK , Schwerk N , et al . Diffuse alveolar hemorrhage in children with interstitial lung disease : determine etiologies !. Pediatr Pulmonol . 2023 ; 58:1106 – 1121 .
5 . MartÌnez-MartÌnez MU , Abud-Mendoza C . Diffuse alveolar hemorrhage in patients with systemic lupus erythematosus . Clinical manifestations , treatment , and prognosis . Reumatol Clin . 2014 ; 10:248 – 253 .
6 . Pappas MD , Sarnaik AP , Meert KL , Hasan RA , Lieh-Lai MW . Idiopathic pulmonary hemorrhage in infancy . Clinical features and management with high frequency ventilation . Chest . 1996 ; 110:553 – 555 .
7 . Delvino P , Monti S , Balduzzi S , Belliato M , Montecucco C , Caporali R . The role of extra-corporeal membrane oxygenation ( ECMO ) in the treatment of diffuse alveolar haemorrhage secondary to ANCA-associated vasculitis : report of two cases and review of the literature . Rheumatol Int . 2019 ; 39:367 – 375 .
8 . Udi J , Köhler TC , Grohmann J , et al . A challenging case of severe pulmonary bleeding in a patient with congenital ventricular septal defect ( VSD ) and Eisenmenger syndrome : extracorporeal membrane oxygenation ( ECMO ) support and weaning strategies . Clin Res Cardiol . 2020 ; 109:403 – 407 .
9 . Kimura D , Shah S , Briceno-Medina M , et al . Management of massive diffuse alveolar hemorrhage in a child with systemic lupus erythematosus . J Intensive Care . 2015 ; 3:10 .
10 . Chakraborty A , Beasley G , Martinez H , et al . Selumetinib for refractory pulmonary and gastrointestinal bleeding in noonan syndrome . Pediatrics . 2022 ; 150 : e2022056336 .
11 . Pacheco Claudio C , Charbonney E , Durand M , Kolan C , Laskine M . Extracorporeal membrane oxygenation in diffuse alveolar hemorrhage secondary to systemic lupus erythematosus . J Clin Med Res . 2014 ; 6:145 – 148 .
12 . Ahmed SH , Aziz T , Cochran J , Highland K . Use of extracorporeal membrane oxygenation in a patient with diffuse alveolar hemorrhage . Chest . 2004 ; 126:305 – 309 .
13 . Kolovos NS , Schuerer DJ , Moler FW , et al . Extracorporeal life support for pulmonary hemorrhage in children : a case series . Crit Care Med . 2002 ; 30:577 – 580 .