Large dual-lumen veno-venous (VV) extracorporeal membrane oxygenation (ECMO) cannulas may increase venous pressure in the brain, contributing to intracranial hemorrhage (ICH). A retrospective cohort study was performed using the extracorporeal life support organization (ELSO) registry. Propensity score matching was used to control for confounding. The rate of ICH and rates of hemolysis, cannula complications, and mortality were compared between patients with a 27 French dual-lumen cannula and patients with a 31 French dual-lumen cannula. Seven hundred forty-four patients were included in the propensity score-matched cohort. Patients were well matched except there was some residual imbalance in body weight and sex. Patients with a 31 French cannula had an ICH rate of 4.3% compared with 1.6% in patients with a 27 French cannula (p = 0.03). There were no differences in hemolysis, cannula complications, or mortality between groups. After controlling for body weight and sex in the matched cohort, ICH odds remained higher in patients with a 31 French cannula; odds ratio = 2.74, (95% CI = 1.06–7.09, p = 0.03). Our study data suggest that large dual-lumen VV ECMO cannulas are associated with more ICH, and thus, smaller cannulas may be preferable when feasible.
From the *Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
†Cardiothoracic Surgery, New York University, Langone Health, New York, New York
‡Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
§Maastricht University Medical Centre, Maastricht, The Netherlands.
Submitted for consideration April 2018; accepted for publication in revised form October 2018.
Disclosure: The authors have no conflicts of interest to report.
Correspondence: Michael Mazzeffi, Department of Anesthesiology, University of Maryland School of Medicine, 22 South Greene Street S11C00, Baltimore, MD 21201. Email: firstname.lastname@example.org.