title: Successful primary use of VVDL+V ECMO with cephalic drain in neonatal respiratory failure.
abstract: OBJECTIVE
  To describe the use of double-lumen venovenous (VVDL) extracorporeal membrane oxygenation (ECMO) with cephalic draining cannula (VVDL+V) as a primary approach for all neonatal respiratory diagnoses and to compare our single-center experience with data as collected in the Extracorporeal Life Support Organization (ELSO) database.
  
  
  METHODS
  We retrospectively reviewed all cases of ECMO for neonatal respiratory failure performed in the neonatal intensive-care unit at a large referral children's hospital, the Children's Healthcare of Atlanta at Egleston (CHOA-E). Comparisons were then made to neonatal respiratory ECMO data retrieved from the ELSO database.
  
  
  RESULTS
  At CHOA-E 162 of 189 cases were completed with the VVDL+V approach. Survival in the VVDL+V cohort was 89.1% versus 68.7% from ELSO, P<0.001. For those complications considered, the overall risk of complication favored the CHOA-E VVDL+V group as compared with ELSO (odds ratio (OR) 0.71 (0.52-0.7)) as did the risk of neurologic complications (OR 0.29, (0.15-0.58)), including intracranial hemorrhage (OR 0.39 (0.18-0.97), P=0.011).
  
  
  CONCLUSIONS
  The VVDL+V approach can be used successfully as the primary approach for ECMO for neonatal respiratory failure of various etiologies and in this single-center cohort this approach was associated with improved survival and lower rates of complication as compared with the ELSO database.
authors.affiliation: Department of Pediatrics, Emory Children's Center, Emory University, School of Medicine, Atlanta, GA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Roberts
authors.affiliation: Department of Pediatrics, Emory Children's Center, Emory University, School of Medicine, Atlanta, GA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Keene
authors.affiliation: ECMO and Advanced Technologies Department, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Heard
authors.affiliation: Department of Pediatrics, Emory Children's Center, Emory University, School of Medicine, Atlanta, GA, USA.
authors.forename: C
authors.initials: C
authors.lastname: McCracken
authors.affiliation: Department of Pediatrics, Emory Children's Center, Emory University, School of Medicine, Atlanta, GA, USA.
authors.forename: T W
authors.initials: TW
authors.lastname: Gauthier
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D062905:Central Venous Catheters; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000145:classification; D007601:Jugular Veins / Q000601:surgery*; D008297:Male; D012042:Registries; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States