Neonatal extracorporeal membrane oxygenation in Colombia: outcomes, complication burden, and circuit-level constraints in a 15-year single-center cohort.

Background: Neonatal extracorporeal membrane oxygenation (ECMO) is a highly specialized therapy for severe respiratory and/or cardiovascular failure, but data from low- and middle-income countries remain limited. We aimed to describe outcomes, complications, and implementation-related challenges in a 15-year neonatal ECMO cohort from a tertiary referral center in Colombia. Methods: We conducted a retrospective single-center cohort study including neonates younger than 28 days who underwent a single ECMO run between 2010 and 2025. Data were obtained from an institutional dataset derived from the Extracorporeal Life Support Organization registry. ECMO configuration, indication, support duration, complications, and in-hospital mortality were analyzed descriptively. ECMO support was delivered using adapted centrifugal-pump circuits and polymethylpentene oxygenators within a multidisciplinary program in a middle-income setting. Results: Seventy neonates were included. ECMO support was predominantly venoarterial (68/70, 97.1%). Congenital heart disease was the most common diagnostic category (31/70, 44.3%). Overall in-hospital mortality was 47.1%. Overall ECMO median duration of 120 h (interquartile range, 76-217). At least one complication occurred in 40 patients (57.1%), the most frequent complications were renal replacement therapy (12.9%), cardiopulmonary resuscitation events (12.9%), circuit thrombosis (8.6%), and pulmonary hemorrhage (7.1%). Longer ECMO duration was associated with both complications and mortality. Conclusions: Neonatal ECMO can be delivered in a middle-income country within a structured multidisciplinary program. Outcomes appear influenced not only by clinical severity, but also by circuit-related constraints, hemocompatibility challenges, monitoring capacity, and resource-adapted care models.