Venovenous Versus Venoarterial Extracorporeal Membranous Oxygenation in Inotrope Dependent Pediatric Patients With Respiratory Failure.

Patients with respiratory failure requiring inotropes or vasopressors are often placed on venoarterial (VA) extracorporeal membrane oxygenation (ECMO), as venovenous (VV) ECMO does not provide direct circulatory support. This retrospective multicenter study compared outcomes for 103 pediatric patients, with hemodynamic compromise, placed on VV ECMO for respiratory failure to those placed on VA ECMO. The primary outcome was survival to hospital discharge. Fifty-seven (55%) study participants were supported on VV ECMO. The two groups had similar PRISM III scores at pediatric intensive care unit (PICU) admission, and vasoactive-inotropic scores at ECMO cannulation. More VV ECMO patients received inhaled nitric oxide (iNO) (54.4 vs. 34.8%; p = 0.04) and had a higher oxygenation index (median 41.5 vs. 19.5; p = 0.04) pre-ECMO. More VA ECMO patients had cardiac dysfunction and cardiac arrest pre-ECMO (50 vs. 14%; p < 0.0001). In univariable analysis, survival to hospital discharge was higher in the VV vs. VA ECMO group (72 vs. 44%; p = 0.005), however, in multivariable models, cannulation type was confounded by cardiopulmonary resuscitation and was not independently associated with survival. VV survivors had longer ECMO duration compared with VA survivors (median, 7 vs. 4.5 days; p = 0.036) but similar PICU and hospital days. No significant difference was noted in functional outcomes or comorbidities at discharge. Cannulation type is not independently associated with survival to hospital discharge in pediatric patients on vasoactive infusions at the time of ECMO cannulation for respiratory indications.

Jaber B ，Bembea MM ，Loftis LL ，Spinella PC ，Zhang L ，Simpson PM ，Hanson SJ ，the Pediatric ECMO (PediECMO) Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Extracorporeal Life Support Organization (ELSO) ... -  《-》

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 ... -  《-》

Primary use of the venovenous approach for extracorporeal membrane oxygenation in pediatric acute respiratory failure.

Pettignano R ，Fortenberry JD ，Heard ML ，Labuz MD ，Kesser KC ，Tanner AJ ，Wagoner SF ，Heggen J ... -  《Pediatric Critical Care Medicine》

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 ... -  《-》

Venovenous versus venoarterial extracorporeal life support for pediatric respiratory failure: are there differences in survival and acute complications?

Zahraa JN ，Moler FW ，Annich GM ，Maxvold NJ ，Bartlett RH ，Custer JR ... -  《CRITICAL CARE MEDICINE》