• Jennifer L Carpenter, Yangyang R Yu, Darrell L Cass, Oluyinka O Olutoye, James A Thomas, Cole Burgman, Caraciolo J Fernandes, and Timothy C Lee.
• Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, 6701 Fannin St, Suite 1210, Houston, TX, 77030, USA.
• Pediatr. Surg. Int. 2018 Mar 1; 34 (3): 263-268.

BackgroundAdvances in extracorporeal membrane oxygenation (ECMO) have led to increased use of venovenous (VV) ECMO in the pediatric population. We present the evolution and experience of pediatric VV ECMO at a tertiary care institution.MethodsA retrospective cohort study from 01/2005 to 07/2016 was performed, comparing by cannulation mode. Survival to discharge, complications, and decannulation analyses were performed.ResultsIn total, 160 patients (105 NICU, 55 PICU) required 13 ± 11 days of ECMO. VV cannulation was used primarily in 83 patients with 64% survival, while venoarterial (VA) ECMO was used in 77 patients with 54% survival. Overall, 74% of patients (n = 118) were successfully decannulated; 57% survived to discharge. VA ECMO had a higher rate of intra-cranial hemorrhage than VV (22 vs 9%, p = 0.003). Sixteen VA patients (21%) had radiographic evidence of a cerebral ischemic insult. No cardiac complications occurred with the use of dual-lumen VV cannulas. There were no differences in complications (p = 0.40) or re-operations (p = 0.85) between the VV and VA groups.ConclusionDual-lumen VV ECMO can be safely performed with appropriate image guidance, is associated with a lower rate of intra-cranial hemorrhage, and may be the preferred first-line mode of ECMO support in appropriately selected NICU and PICU patients.Level Of EvidenceII.

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