Abstract
Background
Advances in extracorporeal membrane oxygenation (ECMO) have led to increased use of venovenous (VV) ECMO in the pediatric population. We present the evolution and experience of pediatric VV ECMO at a tertiary care institution.
Methods
A retrospective cohort study from 01/2005 to 07/2016 was performed, comparing by cannulation mode. Survival to discharge, complications, and decannulation analyses were performed.
Results
In total, 160 patients (105 NICU, 55 PICU) required 13 ± 11 days of ECMO. VV cannulation was used primarily in 83 patients with 64% survival, while venoarterial (VA) ECMO was used in 77 patients with 54% survival. Overall, 74% of patients (n = 118) were successfully decannulated; 57% survived to discharge. VA ECMO had a higher rate of intra-cranial hemorrhage than VV (22 vs 9%, p = 0.003). Sixteen VA patients (21%) had radiographic evidence of a cerebral ischemic insult. No cardiac complications occurred with the use of dual-lumen VV cannulas. There were no differences in complications (p = 0.40) or re-operations (p = 0.85) between the VV and VA groups.
Conclusion
Dual-lumen VV ECMO can be safely performed with appropriate image guidance, is associated with a lower rate of intra-cranial hemorrhage, and may be the preferred first-line mode of ECMO support in appropriately selected NICU and PICU patients.
Level of evidence
II.
Similar content being viewed by others
References
Baffes TG, Fridman JL, Bicoff JP, Whitehill JL (1970) Extracorporeal circulation for support of palliative cardiac surgery in infants. Ann Thorac Surg 10(4):354–63
Bartlett RH, Gazzaniga AB, Huxtable RF, Schippers HC, O’Connor MJ, Jefferies MR (1977) Extracorporeal circulation (ECMO) in neonatal respiratory failure. J Thorac Cardiovasc Surg 74(6):826–33
Cilley RE, Zwischenberger JB, Andrews AF, Bowerman RA, Roloff DW, Bartlett RH (1986) Intracranial hemorrhage during extracorporeal membrane oxygenation in neonates. Pediatrics 78(4):699–704
Ingyinn M, Rais-Bahrami K, Viswanathan M, Short BL (2006) Altered cerebrovascular responses after exposure to venoarterial extracorporeal membrane oxygenation: role of the nitric oxide pathway. Pediatr Crit Care Med 7(4):368–73
Short BL, Walker LK, Traystman RJ (1994) Impaired cerebral autoregulation in the newborn lamb during recovery from severe, prolonged hypoxia, combined with carotid artery and jugular vein ligation. Crit Care Med 22(8):1262–1268
Guner YS, Khemani RG, Qureshi FG, Wee CP, Austin MT, Dorey F et al (2009) Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation. J Pediatr Surg 44(9):1691–701
Andrews AF, Toomasian J, Oram A, Bartlett RH (1982) Total respiratory support with venovenous (VV) ECMO. Trans Am Soc Artif Intern Organs 28:350–353
Klein MD, Andrews AF, Wesley JR, Toomasian J, Nixon C, Roloff D et al (1985) Venovenous perfusion in ECMO for newborn respiratory insufficiency. A clinical comparison with venoarterial perfusion. Ann Surg 201(4):520–526
Delius R, Anderson H 3rd, Schumacher R, Shapiro M, Otsu T, Toft K et al (1993) Venovenous compares favorably with venoarterial access for extracorporeal membrane oxygenation in neonatal respiratory failure. J Thorac Cardiovasc Surg 106(2):329–38
Knight GR, Dudell GG, Evans ML, Grimm PS (1996) A comparison of venovenous and venoarterial extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure. Crit Care Med 24(10):1678–1683
Rais-Bahrami K, Van Meurs KP (2014) Venoarterial versus venovenous ECMO for neonatal respiratory failure. Semin Perinatol 38(2):71–7
Zamora IJ, Shekerdemian L, Fallon SC, Olutoye OO, Cass DL, Rycus PL et al (2014) Outcomes comparing dual-lumen to multisite venovenous ECMO in the pediatric population: the Extracorporeal Life Support Registry experience. J Pediatr Surg 49(10):1452–1457
Berdajs D (2015) Bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: Avalon(c) cannula in childhood disease. Perfusion 30(3):182–186
Keckler SJ, Laituri CA, Ostlie DJ, St Peter SD (2010) A review of venovenous and venoarterial extracorporeal membrane oxygenation in neonates and children. Eur J Pediatr Surg 20(1):1–4
Pettignano R, Fortenberry JD, Heard ML, Labuz MD, Kesser KC, Tanner AJ et al (2003) Primary use of the venovenous approach for extracorporeal membrane oxygenation in pediatric acute respiratory failure. Ped Crit Care Med 4(3):291–298
Fallon SC, Shekerdemian LS, Olutoye OO, Cass DL, Zamora IJ, Nguyen T et al (2013) Initial experience with single-vessel cannulation for venovenous extracorporeal membrane oxygenation in pediatric respiratory failure. Ped Crit Care Med 14(4):366–73
Kugelman A, Gangitano E, Taschuk R, Garza R, Riskin A, McEvoy C et al (2005) Extracorporeal membrane oxygenation in infants with meconium aspiration syndrome: a decade of experience with venovenous ECMO. J Pediatr Surg 40(7):1082–1089
Anderson HL 3rd, Snedecor SM, Otsu T, Bartlett RH (1993) Multicenter comparison of conventional venoarterial access versus venovenous double-lumen catheter access in newborn infants undergoing extracorporeal membrane oxygenation. J Pediatr Surg 28(4):530–534
Tulman DB, Stawicki SP, Whitson BA, Gupta SC, Tripathi RS, Firstenberg MS et al (2014) Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies. BMC Anesthesiol 14:65
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Informed consent
Informed consent was obtained from all individual participants included in the study as per the institutional guidelines stated in the IRB. For this type of study formal consent is not required.
Rights and permissions
About this article
Cite this article
Carpenter, J.L., Yu, Y.R., Cass, D.L. et al. Use of venovenous ECMO for neonatal and pediatric ECMO: a decade of experience at a tertiary children’s hospital. Pediatr Surg Int 34, 263–268 (2018). https://doi.org/10.1007/s00383-018-4225-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-018-4225-5