Multisite Cannulation for Venovenous Extracorporeal Membrane Oxygenation Support in Neonates and Infants: Extracorporeal Life Support Database Study, 2013-2023.

OBJECTIVES

We have evaluated the complications and outcomes of venovenous multisite (VVMS) cannulation for support with extracorporeal membrane oxygenation (ECMO) using the Extracorporeal Life Support Organization (ELSO) registry of neonates (≤ 28 d old) and infants (29-364 d old).

DESIGN

Retrospective ELSO database cohort, comparing outcomes and complications associated with VVMS and venovenous dual lumen (VVDL) cannulation.

PATIENTS: Patients younger than 1 year supported with VV ECMO.

SETTING

ELSO data January 1, 2013 to December 31, 2023.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

We identified 1403 neonates and 603 infants supported with VVDL, and 42 and 77, respectively, with VVMS. At 24 hours of ECMO we found median (interquartile range [IQR]) oxygen saturations (Sa o2 ) were higher in the VVMS compared with the VVDL group: for neonates, 98% (IQR, 93-99%) vs. 94% (IQR, 89-97%); a p value of less than 0.01; and for infants, 94% (IQR, 91-97%) vs. 90% (IQR, 85-95%); a p value of less than 0.01. After adjustment for ventilatory parameters, VVMS was associated with higher mean (95% CI) Sa o2 than VVDL: for neonates by 3.3% (95% CI, 1.0-5.6%); p = 0.005; and for infants by 3.3% (95% CI, 1.3-5.3%); p = 0.002. Higher Sa o2 was also associated with higher flows rather than ventilator parameters. Median flows were higher in the VVMS group compared with VVDL for neonates (111 vs. 101 mL/kg/min) and infants (114 vs. 100 mL/kg/min); a p value of less than 0.01. In general, we failed to identify associations between support technique and mortality or complications. However, in infants, VVMS in comparison with VVDL was associated with fewer mechanical complications (23% vs. 37%; p = 0.02).

CONCLUSIONS

Between 2013 and 2023, in neonatal and infant ECMO, VVMS as opposed to VVDL cannulation was associated with higher ECMO flows and Sa o2 at 24-hour support. We failed to identify associations between support technique and complications or mortality, apart from lower mechanical complications in infants supported using VVMS.