VENOVENOUS EXTRACORPOREAL MEMBRANE-OXYGENATION IN NEWBORN-INFANTS USING THE UMBILICAL VEIN AS A REINFUSION ROUTE

Purpose: The authors report on four neonates treated with venovenous ( VV) extracorporeal membrane oxygenation (ECMO) using the umbilical vei n as a reinfusion route. Methods: From 1994 to 1997, 26 instances VV-E CMO in neonates have been carried out at our neonatal center for the t reatment of severe respiratory and cardiac failure. Among them, 22 pat ients could be treated with W-ECMO mainly using 15F double-lumen cathe ter (DLC), adding the cephalic drainage using another catheter. In the remaining four cases, however, attempts to insert the DLC into the ri ght internal jugular vein failed because the vein was too small or tec hnical problems. For such instances, two catheters were cannulated int o the right atrium and the cephalic portion of the right internal jugu lar vein, respectively. These two venous catheters were connected to t he drainage route of ECMO circuit with a ''Y'' connector. Then, the um bilical vein was cannulated with 10F or 8F catheter, which was connect ed to the reinfusion route of ECMO to return the oxygenated blood to t he infant. Results: The median age at which ECMO was initiated was 18 hours, and the median ECMO course was 72 hours. The liver function tes ts were slightly and transiently worsened in two patients during VV pe rfusion, tin one patient serum glutamic-oxaloacetic transaminase [SGOT ] elevated to 76 IU/L and serum glutamic-pyruvic transaminase [SGPT] t o 49 IU/L, and in another patient SOOT elevated to 56 IU/L and SOFT re mained in normal range). Preumbilical cannula pressures were measured in two patients. In a patient who used 10F umbilical cannula, the preu mbilical maximum pressure was 43 mm Hg at 250 mL/min of ECMO flow. In another with an 8F catheter, it was 72 mm Hg at 180 mL/min of ECMO flo w. All of the patients survived without any neurological complications . Conclusions: If the right internal jugular vein would not accommodat e the DLC, VV-ECMO using the umbilical vein as a infusion route could be selected. Copyright (C) 1998 by W.B. Saunders Company.