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Preferential use of venovenous extracorporeal membrane oxygenation for congenital diaphragmatic hernia.
J Pediatr Surg. 1995 Mar; 30(3):416-9.JP

Abstract

Acute respiratory failure (ARF) secondary to congenital diaphragmatic hernia (CDH), unresponsive to maximal medical management, has traditionally been treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO). Venovenous (VV) ECMO offers several benefits over VA ECMO including preserved pulmonary blood flow, preservation of the carotid artery, and pulsatile flow. However, use of the VV modality has not been widespread because of concerns of the cardiac instability during bypass, and because only one double-lumen (DL) catheter size is available in the United States. The authors hypothesize that VV ECMO is a safe and effective treatment for CDH, symptomatic at birth, and report a single institution experience of preferential VV use for CDH. Over an 18-month period, 14 patients with CDH were placed on ECMO after maximal medical management failed, including high-frequency ventilation and nitric oxide in some cases. Ability to place the 14 Fr DL catheter was the sole criteria for VA or VV selection. Nine patients were successfully placed on VV and 5 on VA; no VV patient required conversion to VA. The two groups of patients were similar with respect to degree of illness, birth weight, EGA, time on and age at start of ECMO. Overall survival for this series was 64%: 66% in the VV group and 60% in the VA group. Two patients in the VV group were found to have congenital heart disease incompatible with life, were withdrawn from therapy and allowed to die, and are listed as treatment failures. The authors conclude that CDH patients receive adequate oxygenation and show hemodynamic stability on VV ECMO.(

ABSTRACT

TRUNCATED AT 250 WORDS)

Authors+Show Affiliations

Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.No 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

7760233

Citation

Heiss, K F., et al. "Preferential Use of Venovenous Extracorporeal Membrane Oxygenation for Congenital Diaphragmatic Hernia." Journal of Pediatric Surgery, vol. 30, no. 3, 1995, pp. 416-9.
Heiss KF, Clark RH, Cornish JD, et al. Preferential use of venovenous extracorporeal membrane oxygenation for congenital diaphragmatic hernia. J Pediatr Surg. 1995;30(3):416-9.
Heiss, K. F., Clark, R. H., Cornish, J. D., Stovroff, M., Ricketts, R., Kesser, K., & Stonecash, M. (1995). Preferential use of venovenous extracorporeal membrane oxygenation for congenital diaphragmatic hernia. Journal of Pediatric Surgery, 30(3), 416-9.
Heiss KF, et al. Preferential Use of Venovenous Extracorporeal Membrane Oxygenation for Congenital Diaphragmatic Hernia. J Pediatr Surg. 1995;30(3):416-9. PubMed PMID: 7760233.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preferential use of venovenous extracorporeal membrane oxygenation for congenital diaphragmatic hernia. AU - Heiss,K F, AU - Clark,R H, AU - Cornish,J D, AU - Stovroff,M, AU - Ricketts,R, AU - Kesser,K, AU - Stonecash,M, PY - 1995/3/1/pubmed PY - 1995/3/1/medline PY - 1995/3/1/entrez SP - 416 EP - 9 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 30 IS - 3 N2 - Acute respiratory failure (ARF) secondary to congenital diaphragmatic hernia (CDH), unresponsive to maximal medical management, has traditionally been treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO). Venovenous (VV) ECMO offers several benefits over VA ECMO including preserved pulmonary blood flow, preservation of the carotid artery, and pulsatile flow. However, use of the VV modality has not been widespread because of concerns of the cardiac instability during bypass, and because only one double-lumen (DL) catheter size is available in the United States. The authors hypothesize that VV ECMO is a safe and effective treatment for CDH, symptomatic at birth, and report a single institution experience of preferential VV use for CDH. Over an 18-month period, 14 patients with CDH were placed on ECMO after maximal medical management failed, including high-frequency ventilation and nitric oxide in some cases. Ability to place the 14 Fr DL catheter was the sole criteria for VA or VV selection. Nine patients were successfully placed on VV and 5 on VA; no VV patient required conversion to VA. The two groups of patients were similar with respect to degree of illness, birth weight, EGA, time on and age at start of ECMO. Overall survival for this series was 64%: 66% in the VV group and 60% in the VA group. Two patients in the VV group were found to have congenital heart disease incompatible with life, were withdrawn from therapy and allowed to die, and are listed as treatment failures. The authors conclude that CDH patients receive adequate oxygenation and show hemodynamic stability on VV ECMO.(ABSTRACT TRUNCATED AT 250 WORDS) SN - 0022-3468 UR - https://www.unboundmedicine.com/medline/citation/7760233/Preferential_use_of_venovenous_extracorporeal_membrane_oxygenation_for_congenital_diaphragmatic_hernia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0022-3468(95)90045-4 DB - PRIME DP - Unbound Medicine ER -