This study examines pediatric cardiac patients with pulmonary hemorrhage (PH) supported on extracorporeal membrane oxygenation (ECMO) using data from the ELSO registry (2011–2020). Analyzing 161 cases, the study identifies high-frequency oscillatory ventilation (HFOV) before ECMO cannulation as a key predictor of survival. The absence of hemorrhagic and renal complications also improved outcomes. Findings suggest that optimized pre-ECMO ventilation strategies may enhance survival rates in these high-risk patients.