Impact of drainage cannula type on patients' fluid balance in venovenous extracorporeal membrane oxygenation: A historical cohort study.

Objective

Positive fluid balance in patients on veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with increased mortality. Drainage insufficiency on VV ECMO is a common occurrence and managed with fluid administration. The use of multi-stage drainage cannulas may result in decreased drainage insufficiency, but it is unclear the effects this may have on patient fluid balance.

Design

A historical cohort study was conducted on adult patients undergoing VV ECMO for acute respiratory failure in femoral-jugular configuration.

Setting

Intensive Care Unit.Patients: Adult patients undergoing VV ECMO for acute respiratory failure.Interventions: Cumulative fluid balance in the first 7 days following initiation of VV ECMO was examined. The relationship between cumulative daily fluid balance over the first 7 days and type of drainage cannula was assessed using mixed methods linear regression.Measurements and Main

Results

We included 82 consecutive patients between April 1st, 2020 and September 1st, 2022. 47 (57%) patients were treated with a single-stage drainage cannula. Our final model showed the use of a multi-stage cannula decreased fluid balance by 740 mL/day (95% CI: -1360 to -118, p = .02) compared to patients with a single-stage drainage cannula for the first 7 days.

Conclusions

The use of multi-stage drainage cannulas resulted in improved fluid balance in patients on VV ECMO in the first 7 days.