Functional Outcomes of Children Supported With Extracorporeal Life Support for Septic Shock

Sunday, March 22, 2026

12:15 PM - 1:15 PM Central Time

Location: Connections Central - RST 17

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Kristin Dolan, Non-Member Physician

Disclosure information not submitted.
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Andrea Ontaneda, MD

Assistant Professor
Baylor College of Medicine Texas Children's Hospital, Texas

Disclosure information not submitted.
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Sameer Thadani, MD

Baylor College of Medicine Texas Children's Hospital, Texas

Disclosure(s): No relevant financial relationship(s) to disclose.
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Katie Brandewie, MD

Pediatric Critical Care Fellow
Baylor College of Medicine/ Texas Children's Hospital

Disclosure information not submitted.
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Nancy Chung, MD

Assistant Professor
UT Southwestern Medical Center

Disclosure information not submitted.
Salvador Maffei, MD (he/him/his)

Baylor College of Medicine Texas Children's Hospital, Texas

Disclosure(s): No relevant financial relationship(s) to disclose.
Marwa Mansour, MD

Texas

Disclosure(s): No relevant financial relationship(s) to disclose.
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Sarah Nelin, MD

Assistant Professor
University of Mississippi Medical Center

Disclosure information not submitted.
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Amanda Ruth, MD

Assistant Professor
Baylor College of Medicine Texas Children's Hospital

Disclosure information not submitted.
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Ayse Akcan Arikan, MD

Baylor College of Medicine at Texas Childrens Hospital, Texas

Disclosure information not submitted.

Introduction: Pediatric sepsis remains a leading cause of morbidity and mortality. Extracorporeal Membrane Oxygenation (ECMO) is indicated in refractory septic shock and has been shown to improve survival in select pediatric patients but significant morbidity and mortality persists. Functional Status Scale (FSS) is a standardized tool to evaluate physical and cognitive morbidities beyond survival. We aim to evaluate the functional outcomes at hospital discharge of pediatric patients supported with ECMO for severe septic shock.

Methods: This is a retrospective cohort study of children < 18 years who received ECMO for severe septic shock and survived to hospital discharge from 2013 to 2025. FSS was calculated at hospital admission (baseline) and hospital discharge and classified as good (6-7), mildly abnormal (8-9), moderately abnormal (10-15), severely abnormal (16-20), or very severely abnormal (21-30). If the FSS score increased more than or equal to 3 total points or more than 2 in one category, this was considered a new morbidity.

Results: Forty-four patients, median age 4.5 years (IQR 0.95,10.2) received venoarterial (VA) ECMO for severe septic shock and survived to discharge. Median ECMO duration was 8 (IQR 6,11) days and 55% (24/44) had central cannulation. At baseline, the median FSS was 6 (IQR 6,6) with 84% of patients classified as good. Median discharge FSS was 8 (IQR 7,10) with 36% (16/44) classified as good and 25% (11/44) moderately abnormal. Overall, 70% (31/44) had worse FSS from baseline and 50% (22/44) acquired a new morbidity. Of the 22 patients with new morbidity in a single category, 60% (6/10) had decline in feeding and 40% (4/10) in motor function. On univariate analysis, no variables were associated with new morbidity at hospital discharge including cannulation strategy or duration of ECMO. Notably, 6 patients required inpatient rehabilitation after discharge.

Conclusions: Children who survived to hospital discharge following VA ECMO support for severe septic shock have significant functional decline compared to their baseline with half acquiring new morbidity. Further analysis of patient centered risk factors as well as longitudinal evaluation is warranted in this vulnerable patient population to better understand their functional morbidity and comprehensive follow up needs.