Ease of Conversion from Venovenous Extracorporeal Membrane Oxygenation to Cardiopulmonary Bypass and Venoarterial Extracorporeal Membrane Oxygenation with a Bicaval Dual Lumen Catheter

Bacchetta, Matthew; Javidfar, Jeffrey; Sonett, Joshua R.; Kim, Hyonah; Zwischenberger, Joseph B.; Wang, Dongfang

doi:10.1097/mat.0b013e31821d3f35

Cited by 22 publications

(18 citation statements)

References 6 publications

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“…The level of CSF glucose is typically interpreted in relation to that of serum glucose, since glucose passes across the bloodbrain barrier. 3 Standard reference texts cite the normal ratio of CSF to serum glucose as 0.6, 4 although this ratio has not been rigorously investigated. 5 Our retrospective cross-sectional study included children 18 years of age or younger who underwent lumbar puncture for clinical indications in the emergency department of a single tertiarycare hospital between January 1, 1995, and September 15, 2011.…”

Section: Relationship Between Cerebrospinal Fluid Glucose and Serum Gmentioning

confidence: 99%

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Relationship between Cerebrospinal Fluid Glucose and Serum Glucose

Nigrovic¹,

Kimia²,

Shah³

et al. 2012

N Engl J Med

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Section: Relationship Between Cerebrospinal Fluid Glucose and Serum Gmentioning

confidence: 99%

“…This approach addresses the issue of limb ischemia while also providing adequate upper-body oxygenation. 2,3 Alternatively, sufficient oxygen to the upper body may be delivered with the use of a venous reinfusion cannula in the internal jugular vein, in addition to the femoral arterial reinfusion cannula.…”

mentioning

confidence: 99%

Relationship between Cerebrospinal Fluid Glucose and Serum Glucose

Nigrovic¹,

Kimia²,

Shah³

et al. 2012

N Engl J Med

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“…Pulmonary vascular resistance was increased from 3.4 Wood units to 12.2 Wood units in 20 steps, by decreasing the radius of the pulmonary resistance arteries by 2.0% per step, mimicking a clinical scenario where a patient with VV-ECMO deteriorates and becomes a candidate for veno-arterial support (17) or septostomy (18). VV-ECMO flow (VCI+VCS→RA) was kept constant at 4 l/min.…”

Section: Oxygen Transportmentioning

confidence: 99%

Recirculation during Veno-Venous Extra-Corporeal Membrane Oxygenation – a Simulation Study

et al. 2014

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therefore total dependency on the ECMO circuit. The optimal degree of lung rest may therefore depend not only on pulmonary pathophysiology, but also the center-specific risk of technical complications during ECMO treatment. Left ventricular and arterial oxygen saturation during VV-ECMO with collapsed lungs may approach the saturation in the pulmonary artery. This saturation is determined by the efficiency of VV-ECMO therapy, lung function, cardiac output, and oxygen consumption. The blood leaving the oxygenator in the ECMO circuit is normally fully saturated, but blood reaching the right ventricle is mixing with venous blood to varying degrees depending on many factors including cannula positions, cardiac output, and ECMO flow (7).Recirculation of oxygenated blood in the ECMO circuit decreases efficiency of oxygen delivery to the patient, but is difficult to measure clinically (8). Reported values vary between 2% and 57% (8-11). Neither measurement of saturation in true mixed venous blood (S v O 2 ) nor conventional thermodilution cardiac output measurements is possible due to venous admixture of oxygenated blood. It is important to realize that blood sampling in the pulmonary artery will result in higher saturation values than S v O 2 and therefore has a questionable clinical value. Since high venous saturation (S preox O 2 ) in the

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“…This prevents stasis and clot formation within this limb. This technique has been similarly described with success in the adult population, where the Avalon cannula was attached to a Y-connector and used as the venous drainage system for both cardiopulmonary bypass and VA-ECMO via the axillary artery (17). Another concern over conversion rates in dual-lumen VV-ECMO is due to the supposition that adequate flow rates cannot be achieved through an overall smaller cannula diameter; however, our patients were all able to establish adequate flow rates based on their weight (Fig.…”

Section: Discussionmentioning

confidence: 99%

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

Fallon

Shekerdemian²,

Olutoye

et al. 2013

Pediatric Critical Care Medicine

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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.

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Ease of Conversion from Venovenous Extracorporeal Membrane Oxygenation to Cardiopulmonary Bypass and Venoarterial Extracorporeal Membrane Oxygenation with a Bicaval Dual Lumen Catheter

Cited by 22 publications

References 6 publications

Relationship between Cerebrospinal Fluid Glucose and Serum Glucose

Relationship between Cerebrospinal Fluid Glucose and Serum Glucose

Recirculation during Veno-Venous Extra-Corporeal Membrane Oxygenation – a Simulation Study

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

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