• Pediatr Crit Care Me · Aug 2020

    Factors Behind Decline of Venovenous Extracorporeal Membrane Oxygenation to Support Neonatal Respiratory Failure.

    • Jon Lillie, Liz Boot, Simone Speggiorin, and Andrew G Nyman.
    • All authors: Pediatric Intensive Care, Evelina London Children's Hospital, Westminster Bridge Road, London, United Kingdom.
    • Pediatr Crit Care Me. 2020 Aug 1; 21 (8): e502-e504.

    ObjectivesNeonates with respiratory failure are ideally supported with venovenous rather than venoarterial extracorporeal membrane oxygenation due to the reduced rate of neurologic complications. However, the proportion of neonates supported with venovenous extracorporeal membrane oxygenation is declining. We aimed to explore the factors behind this decline.DesignWe conducted a survey in order to understand current practice across the United Kingdom, exploring barriers to neonatal venovenous extracorporeal membrane oxygenation in addition to collecting U.K.-wide retrospective data from 2000 onwards.PatientsNeonates with respiratory failure supported with extracorporeal membrane oxygenation in the United Kingdom.SettingAll 11 pediatric U.K. extracorporeal membrane oxygenation centers provided data.InterventionsNone.Measurements And Main ResultsThe percentage of neonates with respiratory failure supported with venovenous extracorporeal membrane oxygenation has declined from 58% to 16% over the last decade, reflected internationally with a decrease of 1.3% per year. Nine extracorporeal membrane oxygenation centers are able to offer pediatric venovenous extracorporeal membrane oxygenation, but only four offer neonatal venovenous extracorporeal membrane oxygenation. Of those able to provide neonatal venovenous extracorporeal membrane oxygenation, three centers use dual lumen cannulae and one uses neonatal multisite cannulation. The most frequently cited barriers to neonatal venovenous extracorporeal membrane oxygenation were the lack of availability of a suitable dual lumen cannula with concerns of cardiac perforation and challenges of multisite cannulation due to small caliber femoral veins.ConclusionsThe majority of U.K. centers are unable to provide venovenous extracorporeal membrane oxygenation for neonates due to concerns with availability and suitability of dual lumen cannulae. An alternative to be considered is the use of multisite cannulation, which has been used historically and is currently being used in centers internationally and in the United Kingdom.

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