Use of venovenous ECMO for neonatal and pediatric ECMO: a decade of experience at a tertiary children’s hospital
Male
Infant, Newborn
Infant
Hospitals, Pediatric
Intensive Care Units, Pediatric
Texas
Brain Ischemia
Catheterization
3. Good health
Cohort Studies
Tertiary Care Centers
03 medical and health sciences
Extracorporeal Membrane Oxygenation
0302 clinical medicine
Child, Preschool
Intensive Care Units, Neonatal
Humans
Female
Child
Intracranial Hemorrhages
Retrospective Studies
DOI:
10.1007/s00383-018-4225-5
Publication Date:
2018-01-18T06:27:39Z
AUTHORS (8)
ABSTRACT
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.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.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.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.II.
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