Objective: Pediatric Veno-Arterial Extra Corporeal Membrane Oxygenation (VA ECMO) is a life saving technology associated with high mortality. A successful VA ECMO course requires attention to multiple aspects of patient care, including ECMO and patient parameters. Early, potentially modifiable, risk factors associated with patient mortality should be analyzed and adjusted for when assessing VA ECMO risk profiles. Method: Retrospective single center experience of pediatric patients requiring VA ECMO from January 2021 to October 2023. Laboratory and ECMO flow parameters were extracted from the patients record and analyzed. Risk factors were analyzed using a Cox proportion hazard regression Main Results: There were 45 patients studied. Overall survival was 51%. Upon uncorrected analysis there were no significant differences between the patients who survived and those who died. Utilizing a Cox proportion hazard regression, platelet count, fibrinogen level and creatine level were significant risk factors within the first twenty-four hours of a patient?s ECMO course. Significance: Although we did not find a significant difference among ECMO flow parameters in this study, this work highlights that granular ECMO flow data can be incorporated to risk analysis profiles and potential modeling in pediatric VA ECMO. This study demonstrated, that when controlling for ECMO flow parameters, kidney dysfunction and clotting regulation remain key risk factors for pediatric VA ECMO mortality.

The authors have declared no competing interest.

Soojin Park is supported by the National Institutes of Health (1R01NS131606, 1R01NS129760). Murad Megjhani is supported by the America Heart Association (20Post35210653).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Columbia University IRB committee approved this research study (Protocol # AAAU5398). Research was conducted in accordance with the principles embodied in the Declaration of Helsinki and in accordance with local statutory requirements. This study was a non-treatment, retrospective, observational review of physiologic and ECMO data that was obtained as part of routine standard of care, and the IRB approved a waiver of informed consent.

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Data for this study cannot be readily de-identified and thus data will not be shared.