Use of umbilical vessels for neonatal ECMO cannulation: possibilities and precautions

Extracorporeal membrane oxygenation (ECMO) is being employed with increasing frequency for the treatment of neonates with severe cardiac or respiratory failure. The risks related both to carotid artery and jugular vein ligation continue to cause concern. Use of umbilical vessels for vascular access in ECMO could eliminate many of these risks. The experience to date with this approach is summarized, along with case reports of three patients treated at our center in whom the umbilical vein was cannulated to augment venous drainage. One patient died of causes unrelated to umbilical vein cannulation. One had an uneventful ECMO course and is a normal survivor, and one developed a tension hemopericardium as a complication of the umbilical vein cannulation, but is a normal survivor. Potential risks and benefits of this approach are reviewed.