title: Outcomes comparing dual-lumen to multisite venovenous ECMO in the pediatric population: the Extracorporeal Life Support Registry experience.
abstract: OBJECTIVE
  The purpose of this study is to evaluate outcomes associated with single site dual-lumen venovenous cannulas (VVDL) and to compare them to those associated with multisite VV ECMO (VVMS) cannulation.
  
  
  METHODS
  The Extracorporeal Life Support (ELSO) Registry was reviewed to identify all children 31days to 18years treated with venovenous ECMO from 1998 to 2011 using either VVDL or VVMS techniques. Patient demographics, cannula type, ECMO variables, complications, and patient survival were analyzed.
  
  
  RESULTS
  From 1998 to 2011, 1323 children underwent venovenous ECMO. The annual utilization of VVDL cannulas has increased and recently surpassed VVMS. Fifty-four percent (n=717) of patients had VVDL cannulation. This group was significantly younger and weighed less than the VVMS group. VVDL cannulas demonstrated improved weight-adjusted flow performance than traditional cannulation. Overall survival was comparable, 64.4% and 68.6%, for VVMS and VVDL respectively. VVDL cannulas experienced higher mechanical (26.2% vs. 22.5%; p=0.004) and cardiovascular complications rates (24.4% vs. 21.7%; p=0.03) than VVMS cannulas, but when stratified by VVDL cannula type, there were no differences between wire-reinforced and non-wire reinforced cannulas.
  
  
  CONCLUSIONS
  VVDL cannulation has become the preferred modality for ECMO therapy in children with respiratory failure and it is mainly utilized in younger patients. The use of newer VVDL cannulas may provide improved pump flow performance without substantial additional risk.
authors.affiliation: Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Irving J
authors.initials: IJ
authors.lastname: Zamora
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: Lara
authors.initials: L
authors.lastname: Shekerdemian
authors.affiliation: Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.affiliation: Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
authors.affiliation: Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.affiliation: Extracorporeal Life Support Organization (ELSO), Ann Arbor, MI.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Rycus
authors.affiliation: Division of Respiratory Care, Texas Children's Hospital, Houston, TX.
authors.forename: Cole
authors.initials: C
authors.lastname: Burgman
authors.affiliation: Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX. Electronic address: timlee@bcm.edu.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012042:Registries; D012131:Respiratory Insufficiency / Q000601:surgery*; D016896:Treatment Outcome
keywords: Dual-lumen cannulas; ECMO; Extracorporeal membrane oxygenation; Pediatric ECMO; Venovenous