Venovenous Versus Venoarterial Extracorporeal Membrane Oxygenation for Adult Patients With Acute Respiratory Distress Syndrome Requiring Precannulation Hemodynamic Support: A Review of the ELSO Registry.

In addition to severe hypoxia and hypercapnia, acute respiratory distress syndrome (ARDS) can present with substantial hemodynamic compromise, requiring inotropic or vasopressor support or both. Either venovenous (VV) or venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be offered in this situation. However, a contemporary comparison of these two cannulation strategies has yet to be well described. The Extracorporeal Life Support Organization Registry was reviewed for all cases of adult ARDS in patients that required inotropic agents or vasopressors or both before ECMO initiation (2009 to 2013). Pre-ECMO clinical data, ECMO variables, and outcomes were compared, based on initial cannulation strategy (VV or VA ECMO). Of 717 ECMO runs, there were 591 VV ECMO and 126 VA ECMO cases. Over the study period, the proportion of VA ECMO cases decreased from 20% (n = 37 of 184, 2009 to 2010) to 19% (n = 59 of 312, 2011 to 2012) to 14% (n = 30 of 221, 2013). Conversion from VV ECMO to VA ECMO was 4%. VV ECMO was associated with less gastrointestinal bleeding and hemolysis, but overall rates of bleeding, stroke, and renal failure were similar. Survival to discharge was 58% for VV ECMO in contrast to 43% for VA ECMO (p = 0.002). Multivariable regression analysis revealed VV ECMO to be an independent predictor of survival to discharge relative to VA ECMO. In this review of ARDS patients requiring pre-ECMO hemodynamic support, VV ECMO was not associated with worse survival or complication rates compared with VA ECMO. These data suggest that, in appropriately selected patients, it may be reasonable to initially institute VV ECMO support, reserving VA ECMO for conversion for refractory hypotension.

Kon ZN ，Bittle GJ ，Pasrija C ，Pham SM ，Mazzeffi MA ，Herr DL ，Sanchez PG ，Griffith BP ... -  《-》

Extracorporeal membrane oxygenation in infants with meconium aspiration syndrome: a decade of experience with venovenous ECMO.

Kugelman A ，Gangitano E ，Taschuk R ，Garza R ，Riskin A ，McEvoy C ，Durand M ... -  《-》

Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation.

Guner YS ，Khemani RG ，Qureshi FG ，Wee CP ，Austin MT ，Dorey F ，Rycus PT ，Ford HR ，Friedlich P ，Stein JE ... -  《-》

Venoarterial versus venovenous extracorporeal membrane oxygenation in congenital diaphragmatic hernia: the Extracorporeal Life Support Organization Registry, 1990-1999.

Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) traditionally has been the mode of support used in congenital diaphragmatic hernia (CDH). A few studies report success using venovenous (VV) ECMO. The purpose of this study is to compare outcomes in CDH patients treated with VA and VV. The authors queried the Extracorporeal Life Support Organization Registry for newborns with CDH treated with ECMO from January 1, 1990 through December 31, 1999. They analyzed the pre-ECMO data, ECMO course, and complications. VA was utilized in 2,257 (86%) and VV in 371 (14%) patients. The pre-ECMO status was similar, with greater use of nitric oxide, surfactant, and pressors in VV. Survival rate was similar (58.4% for VV and 52.2% for VA, P =.057). VA was associated with more seizures (12.3% v 6.7%, P =.0024) and cerebral infarction (10.5% v 6.7%, P =.03). Sixty-four treatments were converted from VV to VA (VV-->VA). Survival rate in VV-->VA was not significantly different than VA (43.8% v 52.2%, respectively; P =.23). VV-->VA and VA patients had similar neurologic complications. CDH patients treated with VV and VA have similar survival rates. VA had more neurologic complications. The authors identified no disadvantage to the use of VV as an initial mode of ECMO for CDH, although some infants may need conversion to VA.

Dimmitt RA ，Moss RL ，Rhine WD ，Benitz WE ，Henry MC ，Vanmeurs KP ... -  《-》

Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry.

There are few studies comparing venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) in pediatric noncardiac sepsis patients. Following approval, we reviewed the Extracorporeal Life Support Organization registry data from 1990 to 2008 for patients 0 to 18 years with a diagnosis of sepsis and without diagnosis of congenital heart disease. Survival to discharge was compared between VA and VV ECMO using χ(2) analysis and multivariable logistic regression. Four thousand three hundred thirty-two ECMO runs were reviewed, 3256 VA (75%) and 1076 VV (25%). A majority of VA modality was noted in each decade studied. Overall survival was 68% and was higher in VV (79%) than in VA ECMO (64%, P < .001). Survival decreased with increasing age (73% in newborns ≤ 1 month, 40% in children 1 month to 12 years, and 32% in adolescents >12 years, P < .001). VA ECMO had increased mortality risk after adjustment for age, use of vasoactive agents, and advanced respiratory support (odds ratio, 2.06; 95% confidence interval, 1.74-2.44; P < .001). These data demonstrate improved survival in VV vs. VA ECMO in select pediatric septic patients without congenital heart disease. When technically feasible, physicians should consider VV ECMO as first therapeutic choice in this patient population.

Skinner SC ，Iocono JA ，Ballard HO ，Turner MD ，Ward AN ，Davenport DL ，Paden ML ，Zwischenberger JB ... -  《-》