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Initial Experience With Single-Vessel Cannulation for Venovenous Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure*

Fallon, Sara C. MD1; Shekerdemian, Lara S. MD2; Olutoye, Oluyinka O. MBChB, PhD1; Cass, Darrell L. MD1; Zamora, Irving J. MD1; Nguyen, Trung MD2; Kim, Eugene S. MD1; Larimer, Emily L. BA1; Lee, Timothy C. MD1

Pediatric Critical Care Medicine: May 2013 - Volume 14 - Issue 4 - p 366–373
doi: 10.1097/PCC.0b013e31828a70dc
Feature Articles

Objectives: Venovenous extracorporeal membrane oxygenation has been used to provide cardiopulmonary support in critically ill infants and children. Recently, dual-lumen venovenous extracorporeal membrane oxygenation has gained popularity in the pediatric population. Herein, we report our institutional experience using a bicaval dual-lumen catheter for pediatric venovenous extracorporeal membrane oxygenation support, which has been our unified approach for venovenous extracorporeal membrane oxygenation since 2009.

Design: This study is a retrospective review.

Setting: The setting is a tertiary children’s hospital in a major metropolitan area.

Patients: Between 2009 and 2011, 11 patients were cannulated using a dual-lumen bicaval venous catheter. Patient demographics, cannulation details, circuit complications, complications of catheter use, and patient outcomes were collected from a retrospective chart review.

Interventions: None.

Measurements and Main Results: Eleven of the patients were cannulated for venovenous extracorporeal membrane oxygenation using the dual-lumen bicaval cannula. The median age at the time of venovenous cannulation was 1.9 years (range, 0.14–17.1), and the median weight was 10.2 kg (range, 3–84). Three patients (27%) required conversion to venoarterial extracorporeal membrane oxygenation. The median duration of extracorporeal membrane oxygenation support was 10 days (2–38 days). Fifty-five percent of patients suffered from a bleeding complication (disseminated intravascular coagulation, pulmonary hemorrhage, or intraventricular hemorrhage), and 45% had a circuit complication. Adequate flow rates were achieved in all patients. The overall hospital mortality in the series was 55%. There were no cannula-related complications.

Conclusions: This review presents the first single-institution experience with the dual-lumen Avalon cannula in pediatric patients. Preliminary results indicate that the catheter can be safely placed and has an acceptable complication profile; however, continued study within larger trials is necessary to fully ascertain the clinical profile of this catheter.

1Michael E. DeBakey Department of Surgery, Texas Children’s Hospital Fetal Center, Baylor College of Medicine, Houston, TX.

2Division of Critical Care Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

*See also p. 436.

There are no relevant sources of financial support or relationships with the manufacturing company, Avalon, to report with respect to the contents of this manuscript.

The authors have disclosed that they do not have any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies