Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Cannulation approach and mortality in neonatal ECMO

Abstract

Objective

Identify associations between cannulation approach and mortality in neonates who received ECMO support for respiratory failure.

Study design

A retrospective analysis of neonates receiving ECMO for respiratory indications at a single quaternary-referral NICU. Associations between cannulation approach and mortality were assessed after adjustment for Neo-RESCUERS score. Cox Proportional Hazards (CPH) model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for each variable and outcome.

Results

Among 244 neonates, overall survival was 88%, with 71% undergoing VV cannulation. After adjusting for Neo-RESCUERS score, VA cannulation was associated with higher mortality during ECMO when compared with VV cannulation (HR 4.189, 95% CI 1.480–11.851, P = 0.0069). Disease-specific comparisons revealed no statistical difference in Neo-RESCUERS score between VA and VV cohorts; however, VA cannulation was associated with higher ECMO mortality for neonates with congenital diaphragmatic hernia (50% vs. 5.5%, Χ2 = 8.5965, P = 0.0034) and PPHN (20% vs. 1.8%, Χ2 = 9.1047, P = 0.0025) when compared with VV cannulation.

Conclusion

VA cannulation was associated with increased mortality in neonates while on ECMO for respiratory failure, which was independent of illness severity.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Fig. 1: Neo-RESCUERS by primary indication for ECMO.

Data availability

In accordance with the FAIR Guiding Principles, raw data will be made available to qualified researchers who have provided an intended data use statement.

References

  1. Fallon BP, Gadepalli SK, Hirschl RB. Pediatric and neonatal extracorporeal life support: current state and continuing evolution. Pediatr Surg Int. 2021;37:17–35.

    Article  Google Scholar 

  2. Guimbretiere G, Anselmi A, Roisne A, Lelong B, Corbineau H, Langanay T, et al. Prognostic impact of blood product transfusion in VA and VV ECMO. Perfusion 2019;34:246–53.

    Article  Google Scholar 

  3. Esper SA, Welsby IJ, Subramaniam K, John Wallisch W, Levy JH, Waters JH, et al. Adult extracorporeal membrane oxygenation: an international survey of transfusion and anticoagulation techniques. Vox Sang. 2017;112:443–52.

    Article  CAS  Google Scholar 

  4. Shaheen IS, Harvey B, Watson AR, Pandya HC, Mayer A, Thomas D. Continuous venovenous hemofiltration with or without extracorporeal membrane oxygenation in children. Pediatr Crit Care Med. 2007;8:362–5.

    PubMed  Google Scholar 

  5. Oganization ELS. ELSO International Summary Ann Arbor, Michigan2021 [Available from: https://www.elso.org/Registry/Statistics/InternationalSummary.aspx.

  6. Rais-Bahrami K, Van Meurs KP. Venoarterial versus venovenous ECMO for neonatal respiratory failure. Semin Perinatol. 2014;38:71–7.

    Article  Google Scholar 

  7. Zahraa JN, Moler FW, Annich GM, Maxvold NJ, Bartlett RH, Custer JR. Venovenous versus venoarterial extracorporeal life support for pediatric respiratory failure: are there differences in survival and acute complications? Crit Care Med. 2000;28:521–5.

    Article  CAS  Google Scholar 

  8. Gauger PG, Hirschl RB, Delosh TN, Dechert RE, Tracy T, Bartlett RH. A matched pairs analysis of venoarterial and venovenous extracorporeal life support in neonatal respiratory failure. ASAIO J. 1995;41:M573–9.

    Article  CAS  Google Scholar 

  9. Stansfield BK, Wise L, Ham PB, 3rd, Patel P, Parman M, Jin C, et al. Outcomes following routine antithrombin III replacement during neonatal extracorporeal membrane oxygenation. J Pediatr Surg. 2016.

  10. Sawyer AA, Wise L, Ghosh S, Bhatia J, Stansfield BK. Comparison of transfusion thresholds during neonatal extracorporeal membrane oxygenation. Transfusion 2017;57:2115–20.

    Article  CAS  Google Scholar 

  11. Barbaro RP, Bartlett RH, Chapman RL, Paden ML, Roberts LA, Gebremariam A, et al. Development and Validation of the Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support. J pediatrics. 2016;173:56–61.e3

    Article  Google Scholar 

  12. Skinner SC, Iocono JA, Ballard HO, Turner MD, Ward AN, Davenport DL, et al. Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry. J Pediatr Surg. 2012;47:63–7.

    Article  Google Scholar 

  13. Varnholt V, Lasch P, Sartoris J, Koelfen W, Kachel W, Lorenz C, et al. Prognosis and outcome of neonates treated either with veno-arterial (VA) or veno-venous (VV) ECMO. Int J Artif Organs. 1995;18:569–73.

    Article  CAS  Google Scholar 

  14. Bamat NA, Tharakan SJ, Connelly JT, Hedrick HL, Lorch SA, Rintoul NE, et al. Venoarterial Extracorporeal Life Support for Neonatal Respiratory Failure: Indications and Impact on Mortality. ASAIO J. 2017;63:490–5.

    Article  Google Scholar 

  15. Azizov F, Merkle J, Fatullayev J, Eghbalzadeh K, Djordjevic I, Weber C, et al. Outcomes and factors associated with early mortality in pediatric and neonatal patients requiring extracorporeal membrane oxygenation for heart and lung failure. J Thorac Dis. 2019;11:S871–S88.

    Article  Google Scholar 

  16. Dalton HJ, Garcia-Filion P, Holubkov R, Moler FW, Shanley T, Heidemann S, et al. Association of bleeding and thrombosis with outcome in extracorporeal life support. Pediatr Crit Care Med. 2015;16:167–74.

    Article  Google Scholar 

  17. Carson JL, Carless PA, Hebert PC Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012:CD002042.

  18. Smith A, Hardison D, Bridges B, Pietsch J. Red blood cell transfusion volume and mortality among patients receiving extracorporeal membrane oxygenation. Perfusion 2013;28:54–60.

    Article  Google Scholar 

  19. Duggan EM, Maitre N, Zhai A, Krishnamoorthi H, Voskresensky I, Hardison D, et al. Neonatal carotid repair at ECMO decannulation: patency rates and early neurologic outcomes. J Pediatr Surg. 2015;50:64–8.

    Article  Google Scholar 

  20. Johnson K, Jarboe MD, Mychaliska GB, Barbaro RP, Rycus P, Hirschl RB, et al. Is there a best approach for extracorporeal life support cannulation: a review of the extracorporeal life support organization. J Pediatr Surg. 2018;53:1301–4.

    Article  Google Scholar 

  21. Tu YK, Gunnell D, Gilthorpe MS. Simpson’s Paradox, Lord’s Paradox, and Suppression Effects are the same phenomenon-the reversal paradox. Emerg Themes Epidemiol. 2008;5:2.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

JLG, KCW, LW, and BKS were responsible for study concept and design, JLG and MCS were responsible for data collection, KCW, LW, and BKS directed data collection and provided study oversight, JLW was responsible for statistical analysis. JLG and BKS wrote the first draft of the manuscript; however, all authors contributed to the revision.

Corresponding author

Correspondence to Brian K. Stansfield.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gancar, J.L., Shields, M.C., Christian Walters, K. et al. Cannulation approach and mortality in neonatal ECMO. J Perinatol (2022). https://doi.org/10.1038/s41372-022-01503-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41372-022-01503-5

Search

Quick links