Follow-up of neonates who received ECMO: how are they doing?

Elena Rodríguez Corrales¹, Sara Vigil Vázquez², Ana Belén Bernardo Atienza², Manuel Sánchez Luna^2 3

Affiliations Expand

PMID: 41588134
DOI: 10.1007/s00431-025-06698-1

Abstract

Extracorporeal membrane oxygenation (ECMO) has been used since 1975 to provide temporary cardiorespiratory support in neonates, children, and adults with severe cardiopulmonary conditions unresponsive to conventional therapy. Initially focused on neonatal respiratory failure, ECMO indications have expanded to include older children with cardiac failure or post-cardiopulmonary arrest. Epidemiological data indicate a decline in neonatal respiratory ECMO cases over the recent decades, largely due to advances in conventional therapies. Conversely, neonatal cardiac ECMO has shown a more variable trend, often used perioperatively in congenital heart disease or for myocarditis, cardiomyopathy, and refractory arrhythmias. Survival rates remain relatively stable, although outcomes vary with underlying pathology and disease severity. Long-term follow-up of survivors reveals persistent respiratory, neurodevelopmental, and motor sequelae, particularly in patients with complex or chronic conditions such as congenital diaphragmatic hernia or hypoxic-ischemic encephalopathy. Pulmonary function deficits, cognitive impairments, hearing loss, and motor delays are frequently reported, with earlier rehabilitation and structured follow-up programs shown to improve functional recovery. Multicenter registries highlight the need for standardized assessment protocols to track long-term outcomes and guide interventions.

Conclusion: While neonatal ECMO has become a life-saving intervention for increasingly complex cases, ongoing efforts to refine patient selection, improve management strategies, and implement structured long-term follow-up are essential to minimize morbidity and maximize functional recovery in this vulnerable population.

What is known: • Neonatal ECMO provides life-saving support for infants with severe cardiopulmonary failure when conventional therapies fail. • Survival rates vary depending on the underlying diagnosis, with respiratory ECMO generally showing higher survival than cardiac or extracorporeal cardiopulmonary resuscitation cases.

What is new: • The neonatal ECMO population has become more complex, with higher-risk patients and more prolonged support requirements. • Long-term follow-up reveals that many ECMO survivors continue to face respiratory, neurological, or developmental sequelae.