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Updated: Jul 2, 2026
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Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Multisite Cannulation for Venovenous Extracorporeal Membrane Oxygenation Support in Neonates and Infants:
Jon Lillie1,2, Shane M Tibby1, Peter Rycus3
1Paediatric Intensive Care Evelina London Children's Hospital, London, United Kingdom.
Summary
Venovenous multisite (VVMS) cannulation for extracorporeal membrane oxygenation (ECMO) in neonates and infants shows higher oxygen saturation and flow rates compared to dual lumen (VVDL) cannulation. While generally not linked to mortality or complications, VVMS demonstrated fewer mechanical issues in infants.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary support technologies
- Extracorporeal membrane oxygenation (ECMO) techniques
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital life support system for critically ill neonates and infants.
- Venovenous ECMO configurations, including dual lumen (VVDL) and multisite (VVMS) cannulation, are used to provide respiratory support.
- Comparative outcomes and complication profiles between VVMS and VVDL cannulation in pediatric populations require further elucidation.
Purpose of the Study:
- To evaluate and compare the complications and clinical outcomes of VVMS versus VVDL cannulation in neonates and infants undergoing VV ECMO.
- To analyze the impact of cannulation strategy on physiological parameters such as oxygen saturation (Sao2) and blood flow.
- To identify any significant differences in mortality or specific complication rates between the two VV ECMO techniques.
Main Methods:
- Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) registry.
- Inclusion of neonates (≤ 28 days) and infants (29-364 days) supported with VV ECMO between January 1, 2013, and December 31, 2023.
- Comparison of outcomes and complications between patients receiving VVMS and VVDL cannulation.
Main Results:
- VVMS cannulation was associated with significantly higher median oxygen saturations (Sao2) at 24 hours in both neonates (98% vs. 94%) and infants (94% vs. 90%) compared to VVDL.
- Adjusted analysis revealed VVMS was linked to higher mean Sao2 (3.3% increase in both groups) and higher ECMO flows (111 vs. 101 mL/kg/min in neonates, 114 vs. 100 mL/kg/min in infants).
- No significant association was found between cannulation technique and overall mortality or complications, except for a lower incidence of mechanical complications in infants supported with VVMS (23% vs. 37%).
Conclusions:
- In pediatric VV ECMO, VVMS cannulation demonstrates superior oxygenation and higher circulatory flows compared to VVDL cannulation within the first 24 hours of support.
- The study did not establish a link between VVMS or VVDL cannulation and overall mortality or complication rates.
- VVMS cannulation may offer a benefit in reducing mechanical complications specifically in the infant population undergoing VV ECMO.
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