JHLT Open · Published 2026-05-22 · DOI 10.1016/j.jhlto.2026.100601
Jack Luxford, Ashfaque Quadir, Philip Roberts, Claire Irving, Julian Ayer, Rugambwa M. Muhame, Nitesh Singhal
Background: Neonates with enterovirus myocarditis may require extracorporeal membrane oxygenation (ECMO). The contemporary prognosis and risk factors for mortality of neonates with enterovirus myocarditis supported on ECMO is unknown. Methods: Retrospective cohort study of Extracorporeal Life Support Organization (ELSO) registry patients < 28 days old supported on V-A ECMO with enterovirus myocarditis. Primary outcome was survival to discharge. Secondary outcome was transplant-free survival to discharge. Demographic and ECMO-related variables were assessed as predictors of survival and transplant-free survival to discharge. Results: 163 neonates from 2000 to 2023 required ECMO for enterovirus myocarditis. The indication for ECMO was cardiac in 136 (83.4%) and eCPR in 16 (9.8%). Median duration of ECMO was 9.3 days (IQR 5.9-15.7). Hospital survival was 50.4% overall; 64.6% in the 2018 to 2023 era. ECMO bridge to VAD resulted in hospital mortality in 80%. Transplant-free survival at discharge was 44.2%. Variables negatively associated with hospital survival in multivariable regression analysis were age ≤ 8 days (OR 0.10, 95% CI 0.04-0.28), ECMO duration > 15.7 days (OR 0.29, 95% CI 0.11-0.78), central cannulation (OR 0.24, 95% CI 0.07-0.84), hyperbilirubinaemia (OR 0.15, 95% CI 0.03-0.89) and cerebral infarction (OR 0.07, 95% CI 0.01-0.72). Conclusions: ECMO is an effective bridge to recovery in neonates with enterovirus myocarditis, with contemporary survival comparable to other neonatal indications for extracorporeal support. Risk factors including age ≤ 8 days and ECMO duration > 16 days define a high-risk cohort. Neonates bridged directly to VAD from ECMO have a dismal outcome. There is a critical need to improve outcomes in neonatal enterovirus myocarditis.
Abstract from DOAJ. Public domain (CC0 1.0).
Read the article at the publisher →
Luxford, J., Quadir, A., Roberts, P., et al. (2026). Neonatal enterovirus myocarditis outcomes following extracorporeal membrane oxygenation (NEMO-ECMO): An ELSO registry analysis. JHLT Open. https://doi.org/10.1016/j.jhlto.2026.100601