Venovenous extracorporeal membrane oxygenation in neonates with respiratory failure

doi:10.1016/S0022-3468(83)80178-X

Journal of Pediatric Surgery

Volume 18, Issue 4, August 1983, Pages 339-346

https://doi.org/10.1016/S0022-3468(83)80178-X Get rights and content

Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) has been successful in support of neonates with respiratory failure but requires right common carotid artery ligation. While no shortterm neurologic complications have resulted from neonatal carotid ligation, late complications may occur. For both VA ECMO and venovenous (VV) ECMO, blood is drained from the right atrium via a right internal jugular cannula, oxygenated by a membrane lung, and returned to the patient. VV ECMO spares the carotid by perfusing the oxygenated blood into a vein. VV ECMO gave total respiratory support to three neonates with respiratory failure and each infant survived. In comparison with three similar VA ECMO patients, the VV patients required higher ECMO circuit flow rates and had lower systemic arterial Po₂s. Length of time on ECMO, length of hospital stay, and neurologic outcome were similar in the VV and VA patients. Differences among the patients were related to their primary disease rather than to the mode of ECMO support. The VV patients had cannulation of the femoral vein for perfusion of oxygenated blood. Late complications may occur from femoral vein ligation as well as from carotid ligation so long-term follow-up is needed to assess these two ECMO techniques.

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Since the early use of extracorporeal life support (ECLS), new innovations and technological advancements have augmented the ability to use this technology in children and neonates. Cannulae have been re-designed to maintain structure and allow for single cannula venovenous (VV) ECLS in smaller patients. Circuit technology, including pumps and tubing, has evolved to permit smaller priming volumes and lower flow rates with fewer thrombotic or hemolytic complications. New oxygenator developments also improve efficiency of gas exchange. This paper serves as an overview of recent device developments in ECLS delivery to pediatric and neonatal patients.
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Citation Excerpt :
These are typically packaged with a blunt-ended obturator designed for open placement and a tapered introducer designed for percutaneous placement over a wire using the Seldinger technique. Early VV-ECMO was performed with two separate systemic venous cannulae (IJV and femoral vein) [9]. However, since the development of the dual-lumen VV ECMO cannula, most neonatal VV-ECMO has been performed using single cannula access via the RIJV [6].
In neonates with cardiac and/or respiratory failure, extracorporeal membrane oxygenation (ECMO) continues to be an important method of respiratory and/or cardiovascular support where conventional treatments are failing. ECMO cannulation involves a complex decision-making process to choose the proper ECMO modality and cannulation strategy to match each patient's needs, unique anatomy, and potential complication profile. Initially, all ECMO support involved cannulating both the carotid artery and the internal jugular vein (IJV), known as veno-arterial (VA-ECMO) for cardiac and/or respiratory support. Rarely was cannulation through the chest used. The development of dual-lumen cannulae in the early to mid 1990s addressed the concerns about carotid artery ligation and its impact on neurological outcomes, and allowed single vascular access for veno-venous respiratory support (VV-ECMO). We present a review of cannulation and decannulation techniques for both VA and VV-ECMO in neonates.
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As blood is diverted from the pulmonary circuit, immediate decompression of the right ventricle occurs in VA-ECMO. Venovenous (VV) cannulation is appropriate for patients with severe respiratory failure who do not require cardiac support and uses a major vein for blood drainage and a vein for return of oxygenated blood to the right heart.149,150 Pulmonary and right ventricular hemodynamics are not altered, although the blood entering the pulmonary artery has substantially higher Po2.
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^*

Presented before the 31st Annual Meeting of the Surgical Section of the American Academy of Pediatrics, New York, New York, October 23–24, 1982.

Supported in part by a grant from the National Institutes of Health, HD-15434-03.

¹: From the Department of Surgery, Sections of General Surgery and Pediatric Surgery, and the Department of Pediatrics, University of Michigan Medical School.

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Venovenous extracorporeal membrane oxygenation in neonates with respiratory failure*

J Thorac Cardiovasc Surg

J Pediatr Surg

J Pediatr

J Pediatr

J Thorac Cardiovasc Surg

Lancet