Venovenous vs. Venoarterial Extracorporeal Membrane Oxygenation in Infection-Associated Severe Pediatric Acute Respiratory Distress Syndrome: A Prospective Multicenter Cohort Study

Abstract

BackgroundExtracorporeal membrane oxygenation (ECMO) has been increasingly used as rescue therapy for severe pediatric acute respiratory distress syndrome (PARDS) over the past decade. However, a contemporary comparison of venovenous (VV) and venoarterial (VA) ECMO in PARDS has yet to be well described. Therefore, the objective of our study was to assess the difference between VV and VA ECMO in efficacy and safety for infection-associated severe PARDS patients.MethodsThis prospective multicenter cohort study included patients with infection-associated severe PARDS who received VV or VA ECMO in pediatric intensive care units (PICUs) of eight university hospitals in China between December 2018 to June 2021. The primary outcome was in-hospital mortality. Secondary outcomes included ECMO weaning rate, duration of ECMO and mechanical ventilation (MV), ECMO-related complications, and hospitalization costs.ResultsA total of 94 patients with 26 (27.66%) VV ECMO and 68 (72.34%) VA ECMO were enrolled. Compared to the VA ECMO patients, VV ECMO patients displayed a significantly lower in-hospital mortality (50 vs. 26.92%, p = 0.044) and proportion of neurologic complications, shorter duration of ECMO and MV, but the rate of successfully weaned from ECMO, bleeding, bloodstream infection complications and pump failure were similar. By contrast, oxygenator failure was more frequent in patients receiving VV ECMO. No significant intergroup difference was observed for the hospitalization costs.ConclusionThese positive findings showed the conferred survival advantage and safety of VV ECMO compared with VA ECMO, suggesting that VV ECMO may be an effective initial treatment for patients with infection-associated severe PARDS.

Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in children with leukemia/lymphoma: A retrospective case series

“…To improve the outcome of patients with hematologic malignancies with ARDS, it will be important to better understand the characteristics for ECMO modality and the timing. In severe pARDS, VV-ECMO patients displayed a significantly lower in-hospital mortality (50% vs. 26.9%, p = 0.044) compared to VA-ECMO in a prospective multicenter study ( 5 ). According to the PALICC ( 12 ) suggestion, there is a trend toward a preference for VV- ECMO for respiratory support in children.…”

Experience With the Crescent• Right Atrial Jugular Dual Lumen Catheter for Pediatric Venovenous Extracorporeal Membrane Oxygenation: A Case Series

“…[7][8][9][10] The lack of availability of pediatric and neonatal-sized DLCs for VV ECMO has impacted practice across the globe, 11 nearly eliminating the use of VV ECMO in the neonatal and young pediatric population for several years. 12 Our study was to show the safety and efficacy of the Crescent RA cannula in our patient population. The Crescent RA cannula has proven to maintain low hemolysis generation, increased speed of insertion, and improved flow support in this patient population.…”

Biomarker-Based Risk Stratification Tool in Pediatric Acute Respiratory Distress Syndrome: Single-Center, Longitudinal Validation in a 2014–2019 Cohort

“…Since median time to death in this cohort (years 2011–2017) was 6 days (interquartile range [IQR], 3–13 d [14]), biomarker measurement at a single, early timepoint precludes evaluation of changes over time. Evaluation at later timepoints may also improve precision for predictive enrichment for trials testing therapies applied later in the course of illness, such as advanced modes of ventilation (15, 16), extracorporeal membrane oxygenation (17), or corticosteroids (18, 19). Third, longitudinal performance of the PARDSEVERE model has not been evaluated, and it is unclear whether the model retains prognostic utility after day 0.…”