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Extracorporeal membrane oxygenation cannulation trends for pediatric respiratory failure and central nervous system

Michael D Rollins1, Ania Hubbard, Luke Zabrocki

  • 1Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA. michael.rollins@imail.org

Journal of Pediatric Surgery
|January 17, 2012
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) for pediatric respiratory failure commonly uses venoarterial (VA) support. While carotid and femoral artery cannulation showed similar central nervous system (CNS) injury rates, VA ECMO overall carried higher CNS injury risks than venovenous (VV) support.

Area of Science:

  • Pediatric Critical Care Medicine
  • Extracorporeal Life Support
  • Neurology

Background:

  • Lack of guidelines for arterial cannula sites and associated central nervous system (CNS) injury risks in pediatric extracorporeal membrane oxygenation (ECMO).
  • Need to evaluate cannulation trends and CNS complication rates based on site and support mode in pediatric respiratory failure.

Purpose of the Study:

  • To review cannulation trends in pediatric respiratory failure patients on ECMO.
  • To evaluate central nervous system (CNS) complication rates by cannulation site and support mode.

Main Methods:

  • Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) registry.
  • Inclusion of pediatric patients (<18 years) with respiratory failure from 1993-2007.
  • Primary outcome: radiographic evidence of CNS injury.

Main Results:

  • Venoarterial (VA) ECMO used in 62% of runs; carotid artery cannulation in 93% of VA patients.
  • Femoral artery use increased with patient age (>5 years) and weight (>20 kg); Venovenous (VV) ECMO common in older children (>10 years).
  • No significant difference in CNS injury between carotid and femoral cannulation, but VA support associated with higher CNS injury odds (OR, 1.6) compared to VV support.

Conclusions:

  • VA ECMO is the predominant support mode for pediatric respiratory failure.
  • No significant difference in CNS injury between carotid and femoral artery cannulation sites.
  • VA ECMO support is linked to a significantly higher risk of CNS injury compared to VV ECMO.
Abstract

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