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Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry.
J Pediatr Surg. 2012 Jan; 47(1):63-7.JP

Abstract

BACKGROUND/PURPOSE

There are few studies comparing venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) in pediatric noncardiac sepsis patients.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Authors+Show Affiliations

Division of Pediatric Surgery, University of Kentucky, Lexington, Kentucky 40536-0298, USA. sean.skinner@uky.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22244394

Citation

Skinner, Sean C., et al. "Improved Survival in Venovenous Vs Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Noncardiac Sepsis Patients: a Study of the Extracorporeal Life Support Organization Registry." Journal of Pediatric Surgery, vol. 47, no. 1, 2012, pp. 63-7.
Skinner SC, Iocono JA, Ballard HO, et al. Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry. J Pediatr Surg. 2012;47(1):63-7.
Skinner, S. C., Iocono, J. A., Ballard, H. O., Turner, M. D., Ward, A. N., Davenport, D. L., Paden, M. L., & Zwischenberger, J. B. (2012). Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry. Journal of Pediatric Surgery, 47(1), 63-7. https://doi.org/10.1016/j.jpedsurg.2011.10.018
Skinner SC, et al. Improved Survival in Venovenous Vs Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Noncardiac Sepsis Patients: a Study of the Extracorporeal Life Support Organization Registry. J Pediatr Surg. 2012;47(1):63-7. PubMed PMID: 22244394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry. AU - Skinner,Sean C, AU - Iocono,Joseph A, AU - Ballard,Hubert O, AU - Turner,Marion D, AU - Ward,Austin N, AU - Davenport,Daniel L, AU - Paden,Matthew L, AU - Zwischenberger,Joseph B, PY - 2011/09/26/received PY - 2011/10/06/accepted PY - 2012/1/17/entrez PY - 2012/1/17/pubmed PY - 2012/5/15/medline SP - 63 EP - 7 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 47 IS - 1 N2 - BACKGROUND/PURPOSE: There are few studies comparing venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) in pediatric noncardiac sepsis patients. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/22244394/Improved_survival_in_venovenous_vs_venoarterial_extracorporeal_membrane_oxygenation_for_pediatric_noncardiac_sepsis_patients:_a_study_of_the_Extracorporeal_Life_Support_Organization_registry_ DB - PRIME DP - Unbound Medicine ER -