A COMPARISON OF VENOVENOUS AND VENOARTERIAL EXTRACORPOREAL MEMBRANE-OXYGENATION IN THE TREATMENT OF NEONATAL RESPIRATORY-FAILURE

Objective: To compare the efficacy of venovenous to venoarterial bypas s in an unselected cohort of infants with refractory cardiorespiratory failure. Design: Retrospective cohort analysis. Setting: Two tertiary hospitals capable of providing extracorporeal life support for neonat es with acute respiratory failure. Patients: All San Diego Regional Ex tracorporeal Membrane Oxygenation (ECMO) Program patients treated afte r the adoption of a policy which eliminated traditional restrictions t o venovenous support. Interventions: Venoarterial or venovenous extrac orporeal life support. Measurements and Main Results: Fifty-four infan ts were treated with venovenous bypass; 30 were treated with venoarter ial bypass due to unsuccessful placement of the double lumen venovenou s catheter or inability to exclude congenital heart disease before can nulation. No patient required conversion from venovenous to venoarteri al ECMO, There were no differences in birth weight, gestational age, d iagnosis, or pre-ECMO condition in the two groups, Patients who met EC MO criteria early were more likely to be successfully cannulated with a double-lumen venovenous catheter, Severe hemodynamic compromise was present before cannulation in a comparable percentage of venovenous an d venoarterial patients. During venovenous bypass, mean PaO2 values we re lower but remained in the normoxic range; PaO2 values, ventilatory settings, intravascular volume requirements, inotropic support, and me an duration of ECMO support were not different, The frequency rate of patient and mechanical complications were also comparable, except that the frequency of intravascular thrombosis was significantly lower in patients receiving venovenous ECMO. Survival, the frequency rate of ch ronic lung disease, and neurodevelopmental outcome were similar in the two groups. Conclusions: We conclude that venovenous ECMO using a dou ble lumen venovenous catheter can provide results comparable with veno arterial bypass without the need for carotid artery ligation in an uns elected population of neonatal ECMO candidates, In our experience, rep orted contraindications to venovenous ECMO did not prove to be valid.