Successful primary use of VVDL+V ECMO with cephalic drain in neonatal respiratory failure

Objective:to describe the use of double-lumen venovenous (vvdl) extracorporeal membrane oxygenation (ecmo) with cephalic draining cannula (vvdl+v) as a primary approach for all neonatal respiratory diagnoses and to compare our single-center experience with data as collected in the extracorporeal life support organization (elso) database.study design:we retrospectively reviewed all cases of ecmo for neonatal respiratory failure performed in the neonatal intensive-care unit at a large referral children’s hospital, the children’s healthcare of atlanta at egleston (choa-e). comparisons were then made to neonatal respiratory ecmo data retrieved from the elso database.results:at choa-e 162 of 189 cases were completed with the vvdl+v approach. survival in the vvdl+v cohort was 89.1% versus 68.7% from elso, p<0.001. for those complications considered, the overall risk of complication favored the choa-e vvdl+v group as compared with elso (odds ratio (or) 0.71 (0.52–0.7)) as did the risk of neurologic complications (or 0.29, (0.15–0.58)), including intracranial hemorrhage (or 0.39 (0.18–0.97), p=0.011).conclusion:the vvdl+v approach can be used successfully as the primary approach for ecmo for neonatal respiratory failure of various etiologies and in this single-center cohort this approach was associated with improved survival and lower rates of complication as compared with the elso database.