Extracorporeal membrane oxygenation in pediatric septic shock: A single-center experience in Chile.

BACKGROUND

Refractory septic shock (RSS) in children carries high mortality despite advances in critical care. Extracorporeal membrane oxygenation (ECMO) is a rescue therapy when conventional management fails. Evidence from Latin America remains limited, with no detailed reports from Chile.

METHODS

We conducted a retrospective single-center study (2009-2024) in a Chilean Pediatric ICU. Patients aged 1 month to 17 years with septic shock unresponsive to maximal conventional therapy were included. We analyzed demographics, illness severity, ECMO modality, complications, and outcomes. Primary endpoint was survival to hospital discharge.

RESULTS

Nine patients received ECMO (median age = 6.3 years). All had RSS, frequently associated with severe ARDS. Configurations included venoarterial (VA; n = 4), venovenous (VV; n = 4), and venoarteriovenous (VAV; n = 1), all via peripheral cannulation. Pre-ECMO median vasoactive-inotropic score was 117, and 78% required renal replacement therapy during ECMO. Overall survival was 55% (5/9). Survivors had longer ECMO runs (median 11 days vs 3 days) and ICU stays (median 63 days vs 5 days). Hemorrhage was the most frequent complication (intracranial n = 3; gastrointestinal n = 1). One survivor developed hemiparesis; no cognitive impairment was observed at 1-year follow-up.

CONCLUSIONS

ECMO can be an effective rescue therapy for pediatric RSS, even without central cannulation capability. Distinguishing cardiogenic from vasoplegic phenotypes and identifying severe ARDS guided configuration selection (VA vs VV). These findings highlight the feasibility of peripheral ECMO in carefully selected patients within resource-limited settings, achieving survival comparable to international reports.