A Review of Venovenous and Venoarterial Extracorporeal Membrane Oxygenation in Neonates and Children

Abstract

The use of extracorporeal membrane oxygenation (ECMO) has increased since its inception. As this modality gained wider acceptance, its application in a variety of disease states has increased. The initial use of ECMO required cannulation of both the carotid artery and internal jugular vein (VA ECMO). Ligation of the carotid artery and concern regarding potential long-term sequelae prompted the development of the single cannula venous only (VV ECMO) technique. Various reports in the literature have compared VV ECMO and VA ECMO. We present a review of the literature with regard to both physiology and clinical application.

Extracorporeal Membrane Oxygenation and the Kidney

“…During the early phase of ECMO support, close attention to hemodynamic monitoring is important, as the reduction in vasoactive drugs may increase a patient's susceptibility to hemodynamic fluctuations with considerable impairment of renal blood flow, leading to ischemia-reperfusion-associated AKI [16]. …”

“…AKI) and considerable mortality [21]. As in other extracorporeal treatments, the blood shear stress [21], the exposure to non-self surfaces and the air/blood interface may cause a hypercoagulable state [16] as well as systemic inflammation (fig. 3) [22].…”

Veno-venous ECMO for carbon dioxide removal in a neonate after Norwood operation with an RV-PA shunt

“…In our case, the size of the cannulas was appropriate to maintain PaCO 2 in the normal range. Recent neonatal studies have shown that AV and VV ECLS support are clinically equivalent in terms of outcome in similar neonatal patients with severe respiratory failure [8]. In older children, double-lumen cannulas may facilitate rapid percutaneous establishment of VV ECMO.…”

Interaction between Renal Replacement Therapy and Extracorporeal Membrane Oxygenation Support

“…Studies published after RIFLE systems have reported AKI incidences of approximately 78% in patients with respiratory failure [11] and 81% in post-cardiotomy patients among adults on ECMO [12]. Chang et al have shown that AKI following weaning from ECMO is an important prognostic tool for mortality [13,14].…”