Morbidity of Conversion from Veno-venous to Veno-arterial ECMO in Neonates with Meconium Aspiration or Persistent Pulmonary Hypertension

Retrospective analysis of 3,831 neonates with MAS/PPHN requiring ECMO found that conversion from venovenous to venoarterial support occurred in 5.8% of cases and was associated with longer runs, increased complications, and reduced survival (70% vs 83%) compared to initial VA placement. Lack of surfactant therapy and high-frequency ventilation pre-cannulation independently predicted conversion risk.