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Venovenous versus venoarterial extracorporeal membrane oxygenation in congenital diaphragmatic hernia.
J Pediatr Surg. 2003 Aug; 38(8):1131-6.JP

Abstract

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) has a significant role as a final rescue modality in severe respiratory failure of the newborn with congenital diaphragmatic hernia (CDH). The objective of this study was to compare the efficiency of venovenous (VV) versus venoarterial (VA) ECMO in newborns with CDH.

METHODS

A retrospective report of 11 years experience (1990 through 2001) of a single center, comparing VV and VA ECMO is given. VV ECMO was the preferred rescue modality for respiratory failure unresponsive to maximal medical therapy. Only when the placement of a VV ECMO 14F catheter was not possible, VA ECMO was used. Forty-six patients met ECMO criteria; 26 were treated with VV ECMO and 19 with VA ECMO. One patient underwent conversion from VV to VA ECMO.

RESULTS

Before ECMO, there was no difference between VV and VA ECMO patients in mean oxygenation index (83 v 83), mean airway pressure (18.4 v 18.9 cm H(2)O), ECMO cannulation age (28 v 20 hours), or in the percentage of patients who needed dopamine and dobutamine (100% v 100%). From November 1994, nitric oxide (NO) was available; before ECMO, 11 of 14 (79%) VV ECMO patients received NO versus 9 of 10 (90%) patients in the VA group. VV ECMO patients were larger (3.34 v 2.77 kg; P <.05) and of advanced gestational age (39.0 v 36.9 wk; P <.05) compared with VA ECMO patients. There was no significant difference between VV and VA ECMO patients in survival rate (18 of 26, 69% v 13 of 19, 68%), ECMO duration (152 v 150 hours), time of extubation (32.0 v 33.5 days), age at discharge (73 v 81 days), or incidence of short-term intracranial complications (3.8% v 10.5%) or myocardial stun (3.8% v 15.8%).

CONCLUSIONS

The authors conclude that VV ECMO is as reliable as VA ECMO in newborns with CDH in severe respiratory failure who need ECMO support and who can accommodate the VV double-lumen catheter. Because of its potential advantages, VV ECMO may be the preferred ECMO method in these infants.

Authors+Show Affiliations

Department of Neonatology, Bnai-Zion Medical Center, Technion-Faculty of Medicine, Haifa, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

12891480

Citation

Kugelman, Amir, et al. "Venovenous Versus Venoarterial Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia." Journal of Pediatric Surgery, vol. 38, no. 8, 2003, pp. 1131-6.
Kugelman A, Gangitano E, Pincros J, et al. Venovenous versus venoarterial extracorporeal membrane oxygenation in congenital diaphragmatic hernia. J Pediatr Surg. 2003;38(8):1131-6.
Kugelman, A., Gangitano, E., Pincros, J., Tantivit, P., Taschuk, R., & Durand, M. (2003). Venovenous versus venoarterial extracorporeal membrane oxygenation in congenital diaphragmatic hernia. Journal of Pediatric Surgery, 38(8), 1131-6.
Kugelman A, et al. Venovenous Versus Venoarterial Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia. J Pediatr Surg. 2003;38(8):1131-6. PubMed PMID: 12891480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venovenous versus venoarterial extracorporeal membrane oxygenation in congenital diaphragmatic hernia. AU - Kugelman,Amir, AU - Gangitano,Ernesto, AU - Pincros,Juan, AU - Tantivit,Phuket, AU - Taschuk,Ray, AU - Durand,Manuel, PY - 2003/8/2/pubmed PY - 2003/11/5/medline PY - 2003/8/2/entrez SP - 1131 EP - 6 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 38 IS - 8 N2 - BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has a significant role as a final rescue modality in severe respiratory failure of the newborn with congenital diaphragmatic hernia (CDH). The objective of this study was to compare the efficiency of venovenous (VV) versus venoarterial (VA) ECMO in newborns with CDH. METHODS: A retrospective report of 11 years experience (1990 through 2001) of a single center, comparing VV and VA ECMO is given. VV ECMO was the preferred rescue modality for respiratory failure unresponsive to maximal medical therapy. Only when the placement of a VV ECMO 14F catheter was not possible, VA ECMO was used. Forty-six patients met ECMO criteria; 26 were treated with VV ECMO and 19 with VA ECMO. One patient underwent conversion from VV to VA ECMO. RESULTS: Before ECMO, there was no difference between VV and VA ECMO patients in mean oxygenation index (83 v 83), mean airway pressure (18.4 v 18.9 cm H(2)O), ECMO cannulation age (28 v 20 hours), or in the percentage of patients who needed dopamine and dobutamine (100% v 100%). From November 1994, nitric oxide (NO) was available; before ECMO, 11 of 14 (79%) VV ECMO patients received NO versus 9 of 10 (90%) patients in the VA group. VV ECMO patients were larger (3.34 v 2.77 kg; P <.05) and of advanced gestational age (39.0 v 36.9 wk; P <.05) compared with VA ECMO patients. There was no significant difference between VV and VA ECMO patients in survival rate (18 of 26, 69% v 13 of 19, 68%), ECMO duration (152 v 150 hours), time of extubation (32.0 v 33.5 days), age at discharge (73 v 81 days), or incidence of short-term intracranial complications (3.8% v 10.5%) or myocardial stun (3.8% v 15.8%). CONCLUSIONS: The authors conclude that VV ECMO is as reliable as VA ECMO in newborns with CDH in severe respiratory failure who need ECMO support and who can accommodate the VV double-lumen catheter. Because of its potential advantages, VV ECMO may be the preferred ECMO method in these infants. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/12891480/Venovenous_versus_venoarterial_extracorporeal_membrane_oxygenation_in_congenital_diaphragmatic_hernia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022346803002562 DB - PRIME DP - Unbound Medicine ER -