J. L. Carpenter1, Y. R. Yu1, D. L. Cass1, O. O. Olutoye1, J. A. Thomas2, C. Burgman2, C. J. Fernandes3, T. C. Lee1 1Texas Children’s Hospital,Department Of Surgery,Houston, TX, USA 2Texas Children’s Hospital,Critical Care Section, Department Of Pediatrics,Houston, TX, USA 3Texas Children’s Hospital,Neonatology Section, Department Of Pediatrics,Houston, TX, USA
Introduction:
Recent advances in extracorporeal membrane oxygenation (ECMO) have led to increased use of venovenous (VV) ECMO in the neonatal and pediatric patient population yet there is little data on outcomes related to this technology. Reported complications of dual lumen VV ECMO have included need for venoarterial (VA) conversion and cardiac perforation. We present the evolution and experience of neonatal and pediatric VV ECMO at a tertiary care institution.
Methods:
Records for NICU and PICU patients who received ECMO support from 01/2005 to 07/2016 were reviewed. Comparison groups included cannulation mode and indication for ECMO. Analyses of survival to discharge, complications (metabolic, hemorrhagic, neurologic, renal, cardiovascular, pulmonary, infectious, and mechanical), and decannulation rate were performed with χ2 tests. Kaplan Meier analysis was used to compare survival based on indication for therapy.
Results:
A total of 160 patients (105 NICU, 55 PICU), ages 0 days – 19 years, required 13 ± 11 days of ECMO. Indications were sepsis (8%) and cardiorespiratory failure (92%); of which 44% (n=64) had diaphragmatic hernia. VV ECMO was the primary cannulation mode in 83 patients with a survival of 64%. VA ECMO was used in 77 patients with 54% survival. Nine VV patients (11%) required VA conversion. VV cannulas were placed percutaneously in 45% of patients (n=37) with 16 placed via an existing central line. Ten VV patients were extubated to spontaneous respirations while on ECMO; three survived to discharge. Overall, 74% of patients (n=118) were successfully decannulated and 57% survived to discharge. Since 2010, the frequency of VV cannulation increased from 50% to 85% and the mortality rate was unchanged. VA ECMO was associated with a significantly higher rate of acute intra-cranial hemorrhage than VV (28% vs 9%, p=0.003). There were no differences in survival (p=0.52), complications (p=0.40), or re-operation rate (p=0.85) between VV and VA groups. There were no cardiac injuries with the use of double lumen VV cannulas. Survival by ECMO indication is shown in Figure 1. There is a significant difference in overall survival (p=0.002); septic patients had a median survival of 20 days, whereas patients with cardiorespiratory failure had a median survival of 129 days.
Conclusion:
VV ECMO cannulation is associated with a lower rate of intra-cranial hemorrhage and may be the preferred first-line mode of ECMO support for cardiorespiratory failure. VV can be an effective mode of ECMO support in the both the NICU and PICU populations, though conversion to VA ECMO may occasionally be necessary.
