Successful primary use of VVDL+V ECMO with cephalic drain in neonatal respiratory failure

Roberts, Jessica L.; Keene, Sarah; Heard, Micheal; Gauthier, Theresa W.

doi:10.1038/jp.2015.163

Cited by 15 publications

(9 citation statements)

References 28 publications

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“…Neonates (less than 28 days) requiring ECMO for respiratory failure in the Level IV NICU at Childrenʼs Healthcare of Atlanta at Egleston between January 1, 2010 and December 1, 2016 were identified through a retrospective chart review of the institutional ECMO database; supplemental information was gathered from individual medical records. Patients undergoing ECMO support met our institution specific criteria for ECMO (Table S1, available as supporting information in the online version of this paper), and all patients treated during the time period were included in the study . The institutional review boards at Emory University School of Medicine and Childrenʼs Healthcare of Atlanta approved this study.…”

Section: Methodsmentioning

confidence: 99%

Blood product transfusion and mortality in neonatal extracorporeal membrane oxygenation

et al. 2019

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BACKGROUND: Neonates receiving extracorporeal membrane oxygenation (ECMO) support are transfused large volumes of red blood cells (RBCs) and platelets (PLTs). Transfusions are often administered in response to specific, but largely unstudied thresholds. The aim of this study is to examine the relationship between RBC and PLT transfusion rates and mortality in neonates receiving ECMO support. STUDY DESIGN AND METHODS:We retrospectively examined outcomes of neonates receiving ECMO support in the neonatal intensive care unit (NICU) for respiratory failure between 2010 and 2016 at a single quaternary-referral NICU. We examined the association between RBC and PLT transfusion rate (mL per kg per day) and in-hospital mortality, adjusting for confounding by using a validated composite baseline risk score (Neo-RESCUERS).RESULTS: Among the 110 neonates receiving ECMO support, in-hospital mortality was 28%. The median RBC transfusion rate (mL/kg/d) after cannulation was greater among non-survivors, compared to survivors: 12.4 (IQR 9.3-16.2) versus 7.3 (IQR 5.1-10.3), p < 0.001. Similarly, PLT transfusion rate was greater among non-survivors: 22.9 (9.3-16.2) versus 12.1 (8.4-20.1), p = 0.02. After adjusting for baseline mortality risk, both RBC transfusion (adjusted relative risk per 5 mL/kg/d increase: 1.33; 95% CI 1.05-1.69, p = 0.02) and PLT transfusion (adjusted relative risk per 5 mL/kg/d increase: 1.12; 95% CI 1.02-1.23, p = 0.02) were both associated with in-hospital mortality.CONCLUSIONS: RBC and PLT transfusion rates are associated with in-hospital mortality among neonates receiving ECMO. These data provide a basis for future studies evaluating more restrictive transfusion practices for neonates receiving ECMO support.From the

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Section: Methodsmentioning

confidence: 99%

Blood product transfusion and mortality in neonatal extracorporeal membrane oxygenation

et al. 2019

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“…In our prior report on patterns of MRI brain injury in this population, all major infarctions were observed in the VA ECMO group and internal carotid artery narrowing was observed as a lasting sequelae of arterial cannulation post-ECMO, 16 given that our institutional practice included carotid ligation without vessel repair at decannulation during the study period. Of note, our institutional protocol includes use of a cephalad venous cannula for patients supported with VV ECMO which may be protective against neurological injury, 26 although this has been refuted by some studies 27 leading to institutional variability in this practice. This and other factors specific to institutional differences in ECMO management may affect the generalizability of our study.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation

et al. 2020

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Objective This study aimed to assess the association of clinical risk factors with severity of magnetic resonance imaging (MRI) brain injury in neonatal extracorporeal membrane oxygenation (ECMO) patients. Study Design This is a single-center retrospective study conducted at an outborn level IV neonatal intensive care unit in a free-standing academic children's hospital. Clinical and MRI data from neonates treated with ECMO between 2005 and 2015 were reviewed. MRI injury was graded by two radiologists according to a modified scoring system that assesses parenchymal injury, extra-axial hemorrhage, and cerebrospinal fluid spaces. MRI severity was classified as none (score = 0), mild/moderate (score = 1–13.5), and severe (score ≥ 14). The relationship between selected risk factors and MRI severity was assessed by Chi-square, analysis of variance, and Kruskal–Wallis tests where appropriate. Combinative predictive ability of significant risk factors was assessed by logistic regression analyses. Results MRI data were assessed in 81 neonates treated with ECMO. Veno-arterial (VA) patients had more severe injury compared with veno-venous patients. There was a trend toward less severe injury over time. After controlling for covariates, duration of ECMO remained significantly associated with brain injury, and the risk for severe injury was significantly increased in patients on ECMO beyond 210 hours. Conclusion Risk for brain injury is increased with VA ECMO and with longer duration of ECMO. Improvements in care may be leading to decreasing incidence of brain injury in neonatal ECMO patients. Key Points

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“…Over the years, many studies have reported the benefits of VV ECMO for neonatal respiratory failure. Roberts et al [25] in a single center study compared double-lumen venovenous extracorporeal membrane oxygenation with cephalic draining cannula (VVDL+V ECMO) with data as collected in the ELSO database, with survival rate of 89.1% and 68.7%, respectively. They concluded that VVDL+V approach was associated with improved survival and lower rates of complication as compared with the ELSO database.…”

Section: Discussionmentioning

confidence: 99%

Complications and mortality of venovenous extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure: a systematic review and meta-analysis

Xiong

Zhang

Bao

2019

Preprint

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Successful primary use of VVDL+V ECMO with cephalic drain in neonatal respiratory failure

Abstract: The VVDL+V approach can be used successfully as the primary approach for ECMO for neonatal respiratory failure of various etiologies and in this single-center cohort this approach was associated with improved survival and lower rates of complication as compared with the ELSO database.

Cited by 15 publications

References 28 publications

Blood product transfusion and mortality in neonatal extracorporeal membrane oxygenation

Blood product transfusion and mortality in neonatal extracorporeal membrane oxygenation

Risk Factors for Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation

Complications and mortality of venovenous extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure: a systematic review and meta-analysis

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