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Pediatric single-lumen cannula venovenous extracorporeal membrane oxygenation: a French center experience.
Artif Organs. 2013 Jan; 37(1):57-65.AO

Abstract

Single-lumen cannula venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a special extracorporeal life support (ECLS) technique used for neonatal and pediatric refractory hypoxemia. This is an alternative flow rate ECLS that consists of successive clamping on the drainage and the injection lines. Currently, the Armand-Trousseau's pediatric intensive care unit remains the only pediatric ECMO center proposing this partial assistance. This article details a technical note and a retrospective analysis of our experience in refractory hypoxemia. The retrospective study, from 2007 to 2011, included all pediatric and neonatal patients treated by single-lumen cannula VV ECMO. The study was focused on pre-ECMO patient characteristics and complications during ECMO course. During the last 5 years, 67 pediatric patients were assisted by this single-lumen cannula VV ECMO. Sixty-one patients (91%) were newborns. Thirty-nine patients presented with meconium aspiration syndrome (58%), which was the most frequent etiology. Before cannulation, mean oxygenation index (OI) was 32 ± 11, alveolar-arterial oxygen difference was 604 ± 47 mm Hg, and partial pressure arterial oxygen/fraction inspired oxygen ratio was 59.2 ± 35.8. Forty-eight patients (72%) presented pulmonary hypertension, and 66 patients were treated by nitric oxide (98%). Fifty patients (75%) were treated by vasopressors or inotropic drugs. Average duration of ECMO was 13.2 ± 7.8 days. There were forty-six survivors (69%). The worst prognosis was for respiratory syncytial virus pneumonia. Complications like acute renal injury and hematologic and transfusion acts were not so different than those observed in classical ECMO techniques. Nevertheless, 19 patients presented a stroke (28% of the overall population), but this high rate did not seem to be due to the ECLS technique used. Single-lumen cannula VV ECMO is a partial and efficient ECMO support. Our experience shows that this technique is as efficient and less invasive than two cannulas ECMO. The single-lumen cannula VV ECMO is a simple and safe ECLS support used for neonatal or pediatric refractory hypoxemia. Because this is a partial assistance, it is a promising ECLS support.

Authors+Show Affiliations

Service de Réanimation Néonatale et Pédiatrique, Hôpital Armand-Trousseau, Paris, France. pierre-louis.leger@trs.aphp.frNo 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

23305574

Citation

Léger, Pierre-Louis, et al. "Pediatric Single-lumen Cannula Venovenous Extracorporeal Membrane Oxygenation: a French Center Experience." Artificial Organs, vol. 37, no. 1, 2013, pp. 57-65.
Léger PL, Guilbert J, Isambert S, et al. Pediatric single-lumen cannula venovenous extracorporeal membrane oxygenation: a French center experience. Artif Organs. 2013;37(1):57-65.
Léger, P. L., Guilbert, J., Isambert, S., Le Saché, N., Hallalel, F., Amblard, A., Chevalier, J. Y., & Renolleau, S. (2013). Pediatric single-lumen cannula venovenous extracorporeal membrane oxygenation: a French center experience. Artificial Organs, 37(1), 57-65. https://doi.org/10.1111/aor.12024
Léger PL, et al. Pediatric Single-lumen Cannula Venovenous Extracorporeal Membrane Oxygenation: a French Center Experience. Artif Organs. 2013;37(1):57-65. PubMed PMID: 23305574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pediatric single-lumen cannula venovenous extracorporeal membrane oxygenation: a French center experience. AU - Léger,Pierre-Louis, AU - Guilbert,Julia, AU - Isambert,Ségolène, AU - Le Saché,Nolwenn, AU - Hallalel,Fazia, AU - Amblard,Alain, AU - Chevalier,Jean-Yves, AU - Renolleau,Sylvain, PY - 2013/1/12/entrez PY - 2013/1/12/pubmed PY - 2013/8/3/medline SP - 57 EP - 65 JF - Artificial organs JO - Artif Organs VL - 37 IS - 1 N2 - Single-lumen cannula venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a special extracorporeal life support (ECLS) technique used for neonatal and pediatric refractory hypoxemia. This is an alternative flow rate ECLS that consists of successive clamping on the drainage and the injection lines. Currently, the Armand-Trousseau's pediatric intensive care unit remains the only pediatric ECMO center proposing this partial assistance. This article details a technical note and a retrospective analysis of our experience in refractory hypoxemia. The retrospective study, from 2007 to 2011, included all pediatric and neonatal patients treated by single-lumen cannula VV ECMO. The study was focused on pre-ECMO patient characteristics and complications during ECMO course. During the last 5 years, 67 pediatric patients were assisted by this single-lumen cannula VV ECMO. Sixty-one patients (91%) were newborns. Thirty-nine patients presented with meconium aspiration syndrome (58%), which was the most frequent etiology. Before cannulation, mean oxygenation index (OI) was 32 ± 11, alveolar-arterial oxygen difference was 604 ± 47 mm Hg, and partial pressure arterial oxygen/fraction inspired oxygen ratio was 59.2 ± 35.8. Forty-eight patients (72%) presented pulmonary hypertension, and 66 patients were treated by nitric oxide (98%). Fifty patients (75%) were treated by vasopressors or inotropic drugs. Average duration of ECMO was 13.2 ± 7.8 days. There were forty-six survivors (69%). The worst prognosis was for respiratory syncytial virus pneumonia. Complications like acute renal injury and hematologic and transfusion acts were not so different than those observed in classical ECMO techniques. Nevertheless, 19 patients presented a stroke (28% of the overall population), but this high rate did not seem to be due to the ECLS technique used. Single-lumen cannula VV ECMO is a partial and efficient ECMO support. Our experience shows that this technique is as efficient and less invasive than two cannulas ECMO. The single-lumen cannula VV ECMO is a simple and safe ECLS support used for neonatal or pediatric refractory hypoxemia. Because this is a partial assistance, it is a promising ECLS support. SN - 1525-1594 UR - https://www.unboundmedicine.com/medline/citation/23305574/Pediatric_single_lumen_cannula_venovenous_extracorporeal_membrane_oxygenation:_a_French_center_experience_ L2 - https://doi.org/10.1111/aor.12024 DB - PRIME DP - Unbound Medicine ER -