title: Venovenous versus venoarterial extracorporeal membrane oxygenation in congenital diaphragmatic hernia.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) has a significant role as a final rescue modality in severe respiratory failure of the newborn with congenital diaphragmatic hernia (CDH). The objective of this study was to compare the efficiency of venovenous (VV) versus venoarterial (VA) ECMO in newborns with CDH.
  
  
  METHODS
  A retrospective report of 11 years experience (1990 through 2001) of a single center, comparing VV and VA ECMO is given. VV ECMO was the preferred rescue modality for respiratory failure unresponsive to maximal medical therapy. Only when the placement of a VV ECMO 14F catheter was not possible, VA ECMO was used. Forty-six patients met ECMO criteria; 26 were treated with VV ECMO and 19 with VA ECMO. One patient underwent conversion from VV to VA ECMO.
  
  
  RESULTS
  Before ECMO, there was no difference between VV and VA ECMO patients in mean oxygenation index (83 v 83), mean airway pressure (18.4 v 18.9 cm H(2)O), ECMO cannulation age (28 v 20 hours), or in the percentage of patients who needed dopamine and dobutamine (100% v 100%). From November 1994, nitric oxide (NO) was available; before ECMO, 11 of 14 (79%) VV ECMO patients received NO versus 9 of 10 (90%) patients in the VA group. VV ECMO patients were larger (3.34 v 2.77 kg; P <.05) and of advanced gestational age (39.0 v 36.9 wk; P <.05) compared with VA ECMO patients. There was no significant difference between VV and VA ECMO patients in survival rate (18 of 26, 69% v 13 of 19, 68%), ECMO duration (152 v 150 hours), time of extubation (32.0 v 33.5 days), age at discharge (73 v 81 days), or incidence of short-term intracranial complications (3.8% v 10.5%) or myocardial stun (3.8% v 15.8%).
  
  
  CONCLUSIONS
  The authors conclude that VV ECMO is as reliable as VA ECMO in newborns with CDH in severe respiratory failure who need ECMO support and who can accommodate the VV double-lumen catheter. Because of its potential advantages, VV ECMO may be the preferred ECMO method in these infants.
authors.affiliation: Department of Neonatology, Bnai-Zion Medical Center, Technion-Faculty of Medicine, Haifa, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Kugelman
authors.forename: Ernesto
authors.initials: E
authors.lastname: Gangitano
authors.forename: Juan
authors.initials: J
authors.lastname: Pincros
authors.forename: Phuket
authors.initials: P
authors.lastname: Tantivit
authors.forename: Ray
authors.initials: R
authors.lastname: Taschuk
authors.forename: Manuel
authors.initials: M
authors.lastname: Durand
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000628:therapy; D008297:Male; D010100:Oxygen / Q000097:blood; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010100:Oxygen