Associations of cephalad drainage in neonatal veno-venous ECMO - A mixed-effects, propensity score adjusted retrospective analysis of 20 years of ELSO data.

Autor: Perez NP; Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, United States of America; Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America. Electronic address: npperez@mgh.harvard.edu., Witt EE; Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America., Masiakos PT; Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America., Layman I; Department of Surgery, Alpert Medical School of Brown University, Providence, RI, United States of America., Tonna JE; Extracorporeal Life Support Organization, Ann Arbor, MI, United States of America; Department of Cardiothoracic Surgery, Department of Emergency Medicine, University Hospital, University of Utah, Salt Lake City, UT, United States of America., Ortega G; Harvard Medical School, Boston, MA, United States of America; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America., Qureshi FG; Department of Surgery, Division of Pediatric Surgery University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Children's Medical Center Dallas, Dallas, TX, United States of America.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2023 Mar; Vol. 58 (3), pp. 432-439. Date of Electronic Publication: 2022 Oct 06.
DOI: 10.1016/j.jpedsurg.2022.09.044
Abstrakt: Background: Neurologic complications can occur during neonatal Veno-Venous (VV) ECMO. The addition of a cephalad drainage cannula (i.e., VVDL+V) to dual lumen cannulation (i.e., VVDL) has been advocated to reduce such complications, but previous studies have presented mixed results.
Methods: Data from the ECMO Registry of the Extracorporeal Life Support Organization was used to extract all neonates (≤28 days old) who underwent VV ECMO for respiratory support between 2000 and 2019. Primary outcomes were mortality, conversion to Veno-Arterial (VA) ECMO, pump flows, and complications. A mixed-effects, propensity score adjusted analysis was performed.
Results: 4,275 neonates underwent VV ECMO, 581 (13.6%) via VVDL+V cannulation, and 3,694 (86.4%) via VVDL. On unadjusted analyses, VVDL+V patients had higher rates of mortality (25.5% vs 19.0%, p<0.001), conversion to VA ECMO (14.5% vs 4.1%, p<0.001), and higher pump flows at 4 h from ECMO initiation (112.7 vs 105.5 mL/Kg/min, p<0.001), but lower at 24 h (100.3 vs 104.0 mL/Kg/min, p = 0.004), and a higher proportion of them experienced hemorrhagic (29.3% vs 18.3%, p<0.001), cardiovascular (60.8% vs 45.8%, p<0.001), and mechanical (42.5% vs 32.6%, p<0.001) complications compared to VVDL patients. After adjusting for propensity scores and the multi-level nature of ELSO data, there were no differences in neurologic outcomes, pump flows, or mortality. Rather, VVDL+V cannulation was associated with higher rates of conversion to VA ECMO (adjusted odds ratio [AOR] 43.3, 95% CI 24.3 - 77.4, p<0.001), and increased mechanical (AOR 2.2, 95% CI 1.6 - 3.0, p<0.001) and hemorrhagic (AOR 2.0, 95% CI 1.4 - 3.0, p<0.001) complications.
Conclusions: In this analysis, VVDL+V cannulation was not associated with any improvement in neurologic outcomes, pump flows, or mortality, but was rather associated with higher rates of conversion to Veno-Arterial ECMO, mechanical, and hemorrhagic complications.
Competing Interests: Declarations of Competing Interest None.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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