Original articleOutcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation
Section snippets
Data source
The ELSO registry database was used to compare VV and VA. Since 1976, the average number of VA cases per year increased steadily and peaked in 1990 (Fig. 1). Therefore, we limited our analysis to 15 years from 1991 to 2006 because, before 1991, VV accounted for less than 1% of the total ECMO cases (Fig. 1). The ELSO registry is composed of more than 170 centers and collects pre-ECMO, on-ECMO, and post-ECMO clinical data, as well as the patient's final disposition (intensive care unit discharge
Study population
We identified 4115 neonates with CDH from the ELSO registry between 1991 and 2006. Venoarterial ECMO was performed in 3347 (81%) neonates, whereas VV was performed in 768 (19%), including VV-VA conversions. We excluded 209 (0.05%) patients (n = 50 VV and n = 159 VA) with missing BWs from all of the analyses.
Patient demographics and characteristics are described in Table 1. Mean GA was near term, and the average BW was more than 3000 g. Most (65%) of the neonates were of white racial/ethnic
Discussion
Our current inability to predict which ECMO modality would be more advantageous for infants with CDH is partly because of the fact that no randomized trials have ever been designed to test or assess this issue, and by default, current predictive modeling must rely on retrospective data [8], [9], [10], [19]. The objective of this study was to compare the outcomes of infants with respiratory failure associated with CDH treated with VV or VA after adjusting for disease severity. Using the ELSO
Conclusion
The ELSO registry is the largest and most complete dataset compiled to increase our understanding and allow the study of extracorporeal life support. Clearly, VA is more commonly used in infants with CDH, but the data suggest that VV is being used in sick neonates with increasing frequency, and the difference in unadjusted mortality becomes insignificant after controlling for initial severity of illness. Venoarterial ECMO remains a well-established and accepted method; however, there are
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Cited by (92)
Pediatric ECLS Neurologic Management and Outcomes
2023, Seminars in Pediatric SurgeryNeonatal venoarterial and venovenous ECMO
2023, Seminars in Pediatric SurgeryManagement of the CDH patient on ECLS
2022, Seminars in Fetal and Neonatal MedicineCitation Excerpt :Table 2 summarizes the advantages of both VA and VV ECLS. Several studies have compared VA and VV ECLS in CDH neonates, and none have found a difference in mortality [32–34]. However, these studies were criticized for their inability to control for disease severity [35].
Expanding neonatal ECMO criteria: When is the premature neonate too premature
2022, Seminars in Fetal and Neonatal MedicineCitation Excerpt :Renal complications and on-ECMO inotrope use are common in VV, whereas neurologic complications, including seizures and central nervous system infarcts occur more frequently in VA [42]. Since neurologic complications including seizures and infarcts are more common in VA ECMO [42], these risks must be carefully weighed when cannulating premature neonates onto ECMO since VA ECMO may be the only option given vessel size. There are many limitations to evaluating the existing literature on ECMO in premature neonates.