title: Initial experience with single-vessel cannulation for venovenous extracorporeal membrane oxygenation in pediatric respiratory failure.
abstract: OBJECTIVE
  Venovenous extracorporeal membrane oxygenation has been used to provide cardiopulmonary support in critically ill infants and children. Recently, dual-lumen venovenous extracorporeal membrane oxygenation has gained popularity in the pediatric population. Herein, we report our institutional experience using a bicaval dual-lumen catheter for pediatric venovenous extracorporeal membrane oxygenation support, which has been our unified approach for venovenous extracorporeal membrane oxygenation since 2009.
  
  
  METHODS
  This study is a retrospective review.
  
  
  METHODS
  The setting is a tertiary children's hospital in a major metropolitan area.
  
  
  METHODS
  Between 2009 and 2011, 11 patients were cannulated using a dual-lumen bicaval venous catheter. Patient demographics, cannulation details, circuit complications, complications of catheter use, and patient outcomes were collected from a retrospective chart review.
  
  
  METHODS
  None.
  
  
  RESULTS
  Eleven of the patients were cannulated for venovenous extracorporeal membrane oxygenation using the dual-lumen bicaval cannula. The median age at the time of venovenous cannulation was 1.9 years (range, 0.14-17.1), and the median weight was 10.2 kg (range, 3-84). Three patients (27%) required conversion to venoarterial extracorporeal membrane oxygenation. The median duration of extracorporeal membrane oxygenation support was 10 days (2-38 days). Fifty-five percent of patients suffered from a bleeding complication (disseminated intravascular coagulation, pulmonary hemorrhage, or intraventricular hemorrhage), and 45% had a circuit complication. Adequate flow rates were achieved in all patients. The overall hospital mortality in the series was 55%. There were no cannula-related complications.
  
  
  CONCLUSIONS
  This review presents the first single-institution experience with the dual-lumen Avalon cannula in pediatric patients. Preliminary results indicate that the catheter can be safely placed and has an acceptable complication profile; however, continued study within larger trials is necessary to fully ascertain the clinical profile of this catheter.
authors.affiliation: Michael E. DeBakey Department of Surgery, Texas Children's Hospital Fetal Center, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.forename: Lara S
authors.initials: LS
authors.lastname: Shekerdemian
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.forename: Irving J
authors.initials: IJ
authors.lastname: Zamora
authors.forename: Trung
authors.initials: T
authors.lastname: Nguyen
authors.forename: Eugene S
authors.initials: ES
authors.lastname: Kim
authors.forename: Emily L
authors.initials: EL
authors.lastname: Larimer
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects; D001778:Blood Coagulation Disorders / Q000139:chemically induced; D061807:Catheter Obstruction; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006470:Hemorrhage / Q000139:chemically induced*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000139:chemically induced*; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000925:Anticoagulants
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