Mobile versus in-center ECMO initiation in pediatric patients: a comparative outcome study

BACKGROUND: ECMO is indicated for respiratory or cardiopulmonary failure despite high oxygen levels, advanced ventilation, and patient optimization, when persistent hypoxemia/hypercapnia threatens life. AIM: Compare characteristics and outcomes of children receiving ECLS at a specialized center vs. local hospital initiation followed by mobile ECMO team transport. MATERIAL AND METHODS: A retrospective analysis was conducted of all pediatric patients who received ECMO support in our PICU between 2018 and 2025. Extracorporeal life support was initiated either at our center or at local hospitals by a mobile cardiorespiratory assistance unit. Data collected included demographic characteristics, pre-ECMO parameters, and clinical outcomes. RESULTS: 24 children who underwent ECLS were analyzed. In the mobile group, 15 patients supported with VV ECMO were transported from regional hospitals to our ECMO center; PARDS with failure of conventional therapy was the main indication, and 80% survived to hospital discharge. In the control group, 9 children received either VV or VA ECMO, depending on the underlying respiratory or combined respiratory/cardiac failure, with 78% survival to discharge. Hepatic dysfunction and kidney failure occurred in 47% and 33% of the mobile group, and in 67% and 44% of the control group, respectively, with no statistically significant differences between groups. There were also no significant differences in successful weaning, duration of extracorporeal support, ICU length of stay before ECMO, or ICU mortality rate. CONCLUSIONS: ECLS can be safely initiated bedside in local hospitals with transport to referral centers. Our findings confirmed the effectiveness of establishing an interregional network of mobile cardiorespiratory assistance units.