title: Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry.
abstract: OBJECTIVE
  There are few studies comparing venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) in pediatric noncardiac sepsis patients.
  
  
  METHODS
  Following approval, we reviewed the Extracorporeal Life Support Organization registry data from 1990 to 2008 for patients 0 to 18 years with a diagnosis of sepsis and without diagnosis of congenital heart disease. Survival to discharge was compared between VA and VV ECMO using χ(2) analysis and multivariable logistic regression.
  
  
  RESULTS
  Four thousand three hundred thirty-two ECMO runs were reviewed, 3256 VA (75%) and 1076 VV (25%). A majority of VA modality was noted in each decade studied. Overall survival was 68% and was higher in VV (79%) than in VA ECMO (64%, P < .001). Survival decreased with increasing age (73% in newborns ≤ 1 month, 40% in children 1 month to 12 years, and 32% in adolescents >12 years, P < .001). VA ECMO had increased mortality risk after adjustment for age, use of vasoactive agents, and advanced respiratory support (odds ratio, 2.06; 95% confidence interval, 1.74-2.44; P < .001).
  
  
  CONCLUSIONS
  These data demonstrate improved survival in VV vs. VA ECMO in select pediatric septic patients without congenital heart disease. When technically feasible, physicians should consider VV ECMO as first therapeutic choice in this patient population.
authors.affiliation: Division of Pediatric Surgery, University of Kentucky, Lexington, Kentucky 40536-0298, USA. sean.skinner@uky.edu
authors.forename: Sean C
authors.initials: SC
authors.lastname: Skinner
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Iocono
authors.forename: Hubert O
authors.initials: HO
authors.lastname: Ballard
authors.forename: Marion D
authors.initials: MD
authors.lastname: Turner
authors.forename: Austin N
authors.initials: AN
authors.lastname: Ward
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Davenport
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Paden
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Zwischenberger
mesh_terms: D000293:Adolescent; D001158:Arteries; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D014680:Veins