Venovenous cannulation for extracorporeal membrane oxygenation using a bicaval dual-lumen catheter in neonates.
OBJECTIVE
Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been used as a management strategy for neonates with refractory pulmonary failure. However, VV-ECMO has been limited in neonates secondary to cannula design and patient size. Herein, we describe the use of a bicaval dual-lumen catheter for VV-ECMO in neonates.


METHODS
The medical records of all neonates cannulated for ECMO support with a bicaval dual-lumen 13F catheter from 2008 to 2010 were reviewed.


RESULTS
Nine neonates cannulated with this dual-lumen catheter were identified. The median gestational age was 38 weeks (range, 31-40 weeks), the median weight was 3.4 kg (range, 2.2-5.5 kg), the median age at cannulation was 2 days (range, 1-64 days), and the median duration of ECMO support was 7 days (range, 5-23 days). There were no VV-to-VA conversions. The median pump flow both at 4 and 24 hours postcannulation was 300 mL/min (range, 240-370 mL/min). One patient developed cannula thrombosis, and one required cannula repositioning because of flow recirculation. Overall survival was 56%.


CONCLUSIONS
The dual-lumen bicaval catheter can be safely used in neonates with minimal complications and is our preferred method for VV-ECMO support in the neonatal population.
Texas Children's Fetal Center and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
David A
DA
Lazar
Darrell L
DL
Cass
Oluyinka O
OO
Olutoye
Eugene S
ES
Kim
Stephen E
SE
Welty
Caraciolo J
CJ
Fernandes
Timothy C
TC
Lee
D001835:Body Weight; D002245:Carbon Dioxide / Q000097:blood; D002404:Catheterization / Q000379:methods*; D057785:Catheters; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005865:Gestational Age; D006325:Heart Atria; D006548:Hernia, Diaphragmatic / Q000150:complications; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D007231:Infant, Newborn; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011014:Pneumonia / Q000150:complications; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D014682:Vena Cava, Inferior; D014683:Vena Cava, Superior
D002245:Carbon Dioxide; D010100:Oxygen