Use of bi-caval cannulae for veno-venous ECMO in neonates and children

Abstract

Abstract Purpose Veno-arterial ECMO remains the most common mode of extracorporeal support in infants and children, and despite increases in overall ECMO numbers the utilisation of veno-venous ECMO in neonates appears to be decreasing. We report here outcomes of neonatal and paediatric patients managed with veno-venous ECMO via bi-caval cannulae over a 10-year period in a tertiary referral ICU. Methods Retrospective single-centre case series of veno-venous ECMO cases using dual lumen cannulae over a 10-year period at a tertiary referral paediatric hospital with a low volume ECMO program. Results In the 10-year period 2013–2022, 33 patients required ECMO with 23 receiving veno-arterial ECMO and 10 managed with veno-venous cannulation - 8 with bi-caval cannulae and 2 with multi-site cannulation. Overall survival was 23/33 (69.6%) and in the veno-venous group survival was 7/10 (70%). Median oxygenation index prior to veno-venous cannulation in the 8 patients undergoing bi-caval cannulation was 48 (range 34–54) and median PaO2 was 42 mmHg (range 34–59 mmHg). Duration of ECMO ranged from 7 to 14 days (median 9 days). Complications included migration of the cannula into the hepatic vein, minor and major bleeding, and compromised blood flow secondary to pneumomediastinum. Conclusions Veno-venous ECMO can be reliably established via a single bi-caval cannula in the majority of patients. Outcomes in this small series from a low volume centre are broadly comparable to those reported from the ELSO database.