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Cannulation approach and mortality in neonatal ECMO



Identify associations between cannulation approach and mortality in neonates who received ECMO support for respiratory failure.

Study design

A retrospective analysis of neonates receiving ECMO for respiratory indications at a single quaternary-referral NICU. Associations between cannulation approach and mortality were assessed after adjustment for Neo-RESCUERS score. Cox Proportional Hazards (CPH) model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for each variable and outcome.


Among 244 neonates, overall survival was 88%, with 71% undergoing VV cannulation. After adjusting for Neo-RESCUERS score, VA cannulation was associated with higher mortality during ECMO when compared with VV cannulation (HR 4.189, 95% CI 1.480–11.851, P = 0.0069). Disease-specific comparisons revealed no statistical difference in Neo-RESCUERS score between VA and VV cohorts; however, VA cannulation was associated with higher ECMO mortality for neonates with congenital diaphragmatic hernia (50% vs. 5.5%, Χ2 = 8.5965, P = 0.0034) and PPHN (20% vs. 1.8%, Χ2 = 9.1047, P = 0.0025) when compared with VV cannulation.


VA cannulation was associated with increased mortality in neonates while on ECMO for respiratory failure, which was independent of illness severity.

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Fig. 1: Neo-RESCUERS by primary indication for ECMO.

Data availability

In accordance with the FAIR Guiding Principles, raw data will be made available to qualified researchers who have provided an intended data use statement.


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Author information

Authors and Affiliations



JLG, KCW, LW, and BKS were responsible for study concept and design, JLG and MCS were responsible for data collection, KCW, LW, and BKS directed data collection and provided study oversight, JLW was responsible for statistical analysis. JLG and BKS wrote the first draft of the manuscript; however, all authors contributed to the revision.

Corresponding author

Correspondence to Brian K. Stansfield.

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The authors declare no competing interests.

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Gancar, J.L., Shields, M.C., Christian Walters, K. et al. Cannulation approach and mortality in neonatal ECMO. J Perinatol 43, 196–202 (2023).

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