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Use of venovenous ECMO for neonatal and pediatric ECMO: a decade of experience at a tertiary children’s hospital

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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.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Texas Children’s Hospital/Baylor College of Medicine, 6701 Fannin St, Suite 1210, Houston, TX, 77030, USA

    Jennifer L. Carpenter, Yangyang R. Yu, Darrell L. Cass, Oluyinka O. Olutoye & Timothy C. Lee

  2. Critical Care Section, Department of Pediatrics, Texas Children’s Hospital, 6621 Fannin St, Suite 6006, Houston, TX, 77030, USA

    James A. Thomas & Cole Burgman

  3. Neonatology Section, Department of Pediatrics, Texas Children’s Hospital, 6621 Fannin St, Suite 6104, Houston, TX, 77030, USA

    Caraciolo J. Fernandes

Authors
  1. Jennifer L. Carpenter
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  2. Yangyang R. Yu
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  3. Darrell L. Cass
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  4. Oluyinka O. Olutoye
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  5. James A. Thomas
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  6. Cole Burgman
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  7. Caraciolo J. Fernandes
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  8. Timothy C. Lee
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Correspondence to Timothy C. Lee.

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The authors declare that they have no conflict of interest.

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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.

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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.

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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

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  • DOI: https://doi.org/10.1007/s00383-018-4225-5

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