Journal of cardiac surgery
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Vascular access in children who require extracorporeal membrane oxygenation (ECMO) support can be a challenging endeavor particularly in those who have undergone prior median sternotomies or interventional procedures. We present an alternative cannulation strategy that can be utilized in pediatric patients requiring ECMO that involves utilization of the iliac vein via a retroperitoneal approach.
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We present three patients with severe respiratory failure secondary to H1N1 influenza type A pneumonitis, in whom hypercapnia and respiratory acidosis were not controlled by the conventional mechanical lung ventilation or high-frequency oscillatory ventilation. Use of a pumpless arteriovenous extracorporeal carbon dioxide removal device (Novalung™, Inspiration Healthcare Ltd, Leicester, UK) resulted in reduced carbon dioxide levels, improved pH, and a reduction in inspiratory pressures, allowing for a less-harmful ventilator strategy. These cases demonstrate that the Novalung is a safe and effective device to use in patients with H1N1 pneumonitis refractory to the conventional therapy and may be an alternative to extracorporeal membrane oxygenation (ECMO) in selected cases.