The Edmonton experience with venovenous extracorporeal membrane oxygenation

Background/Purpose: Despite the proven effectiveness of venovenous extracor poreal membrane oxygenation (VV ECMO) in the treatment of neonates with sev ere respiratory failure, this technique is not widely used. The purpose of this study was to assess the authors' policy of preferred use of VV ECMO wi th a cephalad catheter and to compare the results with those of the Extraco rporeal Life Support Organization (ELSO) Registry. Methods: Charts of neonatal ECMO candidates were reviewed retrospectively. Data were collected for gestational age, birth weight, and diagnosis. Sever ity of illness was assessed by oxygenation index, lactate levels, and inotr opic requirements before cannulation. Patients were divided into three grou ps: venovenous (VV), venoarterial (VA), and VV to VA ECMO. A cephalad cathe ter was inserted in the distal part of the jugular vein. Results: Sixty-five neonates were supported with ECMO. Cannulation with a d ouble lumen venovenous (VVDL) catheter was attempted in 63 neonates and suc cessfully accomplished in 57. A survival rate of 86% was observed in neonat es initially placed on VV ECMO. Five neonates initially placed on VV ECMO u nderwent conversion to VA ECMO. Conclusions: This study showed that the authors' preferred policy of VV ECM O did not result in an increase in mortality rate based on a comparison wit h ELSO data. VV ECMO with a cephalad catheter provides adequate support for unstable neonates with respiratory failure. J Pediatr Surg 33:1749-1752. C opyright (C) 1998 by W.B. Saunders Company.