S. C. Bennett1, R. Tripathi3, A. Kilic2, A. Flores3, T. Papadimos3, D. Hayes4, R. S. Higgins1,2, B. A. Whitson2 1Ohio State University,General Surgery,Columbus, OH, USA 2Ohio State University,Cardiothoracic Surgery,Columbus, OH, USA 3Ohio State University,Anesthesiology,Columbus, OH, USA 4Nationwide Children’s Hospital,Pulmonary Medicine,Columbus, OH, USA
Introduction:
Severe acute respiratory failure has a mortality rate of 40 to 60%. Venovenous extracorporeal membrane oxygenation (VV-ECMO) has emerged as an increasingly popular treatment modality showing a significant survival benefit for acute respiratory failure as compared to traditional ventilatory methods. Cannulation for VV-ECMO has traditionally consisted of two separate cannulas. We sought to evaluate the new generation bicaval dual-lumen cannulas (BCDLC) effect on survival and length of stay as compared to single-lumen cannulation.
Methods:
A prospectively maintained, institutional database of all patients undergoing VV-ECMO from January, 2011 through May, 2014 was retrospectively reviewed. Those patients who had respiratory failure associated with cardiac surgery or those converted from venoarterial (VA) ECMO to VV-ECMO were excluded. The technique for bicaval dual-lumen cannulation was as follows. A guidewire was inserted into the inferior vena cava (IVC) via the right internal jugular vein using sterile Seldinger technique and fluoroscopic guidance. The BCDLC was then placed over the wire using serial dilations, and its final position was confirmed by transesophageal echocardiography and fluoroscopy. Femoral cannulation was performed with standard Seldinger technique without initial image guidance.
Results:
During the time period reviewed, 36 patients underwent VV-ECMO. Exclusion criteria was met by 4 patients. Dual-lumen cannulation was used in 12/32 (37.5%) patients. There were no significant differences in age or gender between the two groups. The BCDLC cohort had a lower mean number of days on ECMO 12.33 compared to 13.3 in the single-lumen group, (p=0.442). Mean length of stay was 26.33 days for BCDLC cohort compared to 25.35 in single-lumen group, (p=0.561). Survival to decannulation was 11/12 (91.67%) of BCDLC cohort compared to 11/20 (55%) in the single-lumen group, (p=0.03). Survival to discharge was 9/12 (75%) for BCDLC cohort and 9/20 (45%) for single-lumen group, (p=0.098). Early or concomitant tracheostomy was performed in 7/12 (58.33%) of BCDLC cohort as compared to 2/20 (10%) of single-lumen. During the time period reviewed there was only one complication, right atrial perforation, from dual-lumen cannula insertion thus our incidence of right heart cavity perforation 1/12 (8.3%) was consistent with the 4-15% incidence reported in the literature.
Conclusion:
BCDLC is showing better outcomes in terms of ECMO duration, length of stay, and survival to decannulation. This warrants further comparison of these two groups as well as further data collection pertaining to differences in sedation and mobility. Further efforts need to be made to achieve early mobilization in our adult population, and additional outcomes data will need to be assessed as ambulatory ECMO technology evolves.