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.

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.

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).

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.