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Venoarterial versus venovenous extracorporeal membrane oxygenation in congenital diaphragmatic hernia: the Extracorporeal Life Support Organization Registry, 1990-1999.
J Pediatr Surg. 2001 Aug; 36(8):1199-204.JP

Abstract

BACKGROUND/PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Division of Neonatology, Department of Pediatrics, Stanford University, Stanford, CA 94304, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

11479856

Citation

Dimmitt, R A., et al. "Venoarterial Versus Venovenous Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia: the Extracorporeal Life Support Organization Registry, 1990-1999." Journal of Pediatric Surgery, vol. 36, no. 8, 2001, pp. 1199-204.
Dimmitt RA, Moss RL, Rhine WD, et al. Venoarterial versus venovenous extracorporeal membrane oxygenation in congenital diaphragmatic hernia: the Extracorporeal Life Support Organization Registry, 1990-1999. J Pediatr Surg. 2001;36(8):1199-204.
Dimmitt, R. A., Moss, R. L., Rhine, W. D., Benitz, W. E., Henry, M. C., & Vanmeurs, K. P. (2001). Venoarterial versus venovenous extracorporeal membrane oxygenation in congenital diaphragmatic hernia: the Extracorporeal Life Support Organization Registry, 1990-1999. Journal of Pediatric Surgery, 36(8), 1199-204.
Dimmitt RA, et al. Venoarterial Versus Venovenous Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia: the Extracorporeal Life Support Organization Registry, 1990-1999. J Pediatr Surg. 2001;36(8):1199-204. PubMed PMID: 11479856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venoarterial versus venovenous extracorporeal membrane oxygenation in congenital diaphragmatic hernia: the Extracorporeal Life Support Organization Registry, 1990-1999. AU - Dimmitt,R A, AU - Moss,R L, AU - Rhine,W D, AU - Benitz,W E, AU - Henry,M C, AU - Vanmeurs,K P, PY - 2001/8/2/pubmed PY - 2001/10/12/medline PY - 2001/8/2/entrez SP - 1199 EP - 204 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 36 IS - 8 N2 - BACKGROUND/PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SN - 0022-3468 UR - https://www.unboundmedicine.com/medline/citation/11479856/Venoarterial_versus_venovenous_extracorporeal_membrane_oxygenation_in_congenital_diaphragmatic_hernia:_the_Extracorporeal_Life_Support_Organization_Registry_1990_1999_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022346801115757 DB - PRIME DP - Unbound Medicine ER -