Acute gastrointestinal injury in children on ECMO: an analysis of risk factors

Objective To investigate the risk factors associated with acute gastrointestinal injury (AGI) during extracorporeal membrane oxygenation (ECMO) therapy in pediatric patients. Methods This retrospective study included 62 pediatric patients who were treated with ECMO at Gansu Provincial Maternal and Child Health Hospital and Xi’an Children’s Hospital, Shaanxi Province, from January 2019 to May 2025. Patients were categorized into two groups according to the European Society of Intensive Care Medicine (ESICM) criteria: the significant AGI group (patients with grade II or higher AGI) and the non-significant AGI group (patients without AGI or with grade I AGI). General characteristics and clinical and laboratory parameters were compared between the groups. Binary logistic regression was used to analyze risk factors for significant AGI. Results Significant AGI occurred in 28 (45.16%) patients, while non-significant AGI occurred in 34 (54.84%) patients. Univariate analysis revealed that the duration of ECMO, pre-ECMO blood lactate levels, the vasopressor–inotrope score (VIS), the enteral nutrition initiation time, and pre-ECMO proton pump inhibitor (PPI) use significantly differed between the groups ( P < 0.05). Logistic regression analysis revealed that the ECMO duration, pre-ECMO blood lactate levels, and pre-ECMO PPI use were independent risk factors for significant AGI in pediatric patients receiving ECMO, whereas early (within 48 h) initiation of enteral nutrition was a protective factor. Conclusion The incidence of significant AGI in pediatric patients receiving ECMO therapy is high. Elevated pre-ECMO lactate levels, prolonged ECMO duration, and pre-ECMO PPI use are independent risk factors for significant AGI, whereas early enteral nutrition (within 48 h) is a protective factor.