207: Factors and Outcomes Associated with Circuit Change in the Neonatal and Pediatric ECLS populations: An Analysis of the ELSO Registry

Objectives: Circuit change is one of the most common circuit complications in neonatal and pediatric ECMO. Single-center studies have reported multiple factors associated with circuit change, but no multicenter data reporting the prevalence, factors and outcomes associated with these events exists. Methods: We conducted a multicenter retrospective cohort analysis of 14,185 patients less than 18 years of age in the ELSO international registry who were supported on ECMO from January 2018 to December 2021. A Cox proportional hazards model with center random effect was fit to determine demographic, pre-ECLS, and ECLS variables associated with the risk of circuit change. We also evaluated whether circuit change is associated with other ECLS complications and in-hospital mortality. Results: The primary outcome was time to first circuit change. Factors associated with increased risk of circuit change included neonatal age, center volume ³ 26 runs/yr, ECLS in 2019/2020, bridge to transplant and mechanical cardiac support prior to ECMO. Weight in the 2nd and 3rd quartiles, Asian race and therapeutic hypothermia were associated with decreased risk of circuit change. Significant associations of circuit changes were observed with bleeding, hemolysis and renal replacement therapy. The secondary outcome was odds of in-hospital mortality. Both neonatal and pediatric patients who underwent a circuit change had an increased likelihood of in-hospital mortality when adjusting for ECMO indication. Conclusions: Circuit change is an important clinical marker that is associated with ECLS complications and in-hospital mortality. Key Words: Circuit change, extracorporeal membrane oxygenation, neonates, pediatrics