Venovenous extracorporeal membrane oxygenation for patients with single-ventricle anatomy: A registry report

Abstract

Patients with single-ventricle anatomy in respiratory failure may be treated successfully with venovenous extracorporeal membrane oxygenation, with survival comparable to those treated with venoarterial extracorporeal membrane oxygenation for cardiac failure. Future research on indications for venovenous extracorporeal membrane oxygenation may aid clinicians in deciding the optimal approach for this challenging cohort.

What is new in pediatric ECMO? 2016, a year in review

“…Special thought is necessary given the unique SV physiology, including cannulation, hemorrhagic, thrombotic, circuit flow, and lung rest considerations. Aydin et al performed a retrospective review of the ELSO database and identified 89 SV patients supported with VV ECMO . Sixty‐one percent had shunt physiology, 25% had cavopulmonary connections, and 14% were supported prior to surgery.…”

Venovenous Extracorporeal Life Support in Single-Ventricle Patients with Acute Respiratory Distress Syndrome

“…There are several potential benefits to VV compared to VA ECLS in this population, but also challenges. First, in VV ECLS, fully oxygenated blood from the circuit augments the oxygen content of blood delivered to the lung, which may counteract the increased pulmonary vascular resistance (PVR) that can occur in ARDS ( 29 , 30 ). In single-ventricle patients, potential differences in pulmonary oxygen content between VA and VV ECLS depend on the stage of palliation and cannula position.…”

“…Second, because ventricular ejection provides all systemic blood flow in VV ECLS, pulsatile flow is preserved. Non-pulsatile flow has been shown to increase catecholamine release, which may impair flow through the microcirculation, increase myocardial work through increased systemic afterload, and decrease end-organ perfusion ( 29 , 31 ). Third, VV ECLS might decrease the risk of stroke if blood from the circuit can be returned exclusively to the pulmonary circulation ( 29 , 30 ).…”

“…Non-pulsatile flow has been shown to increase catecholamine release, which may impair flow through the microcirculation, increase myocardial work through increased systemic afterload, and decrease end-organ perfusion ( 29 , 31 ). Third, VV ECLS might decrease the risk of stroke if blood from the circuit can be returned exclusively to the pulmonary circulation ( 29 , 30 ). However, in single-ventricle patients, this situation is uncommon, occurring only in Glenn patients if the inflow cannula (for multisite VV ECLS) is placed in the SVC, in Glenn patients if a dual-lumen single cannula is placed in the SVC, and in patients with an unfenestrated Fontan.…”

“…Indeed, depending on the native ventricular function, anatomy, cannula size, and cannula position, VA ECLS could result in a marked increase in pulmonary blood flow that could aggravate the underlying lung injury. Likewise, higher ECLS flow rates could result in more inflammation, hemolysis, and autoantibody formation ( 29 ). Several of these points will be discussed in further detail below.…”