Extracorporeal membrane oxygenation cannulation trends for pediatric respiratory failure and central nervous system injury

Abstract

Background: Guidelines regarding arterial cannula site and cannula site-specific risks of central nervous system (CNS) injury for pediatric patients requiring extracorporeal membrane oxygenation (ECMO) support are lacking. We reviewed cannulation trends for pediatric respiratory failure and evaluated CNS complication rates by cannulation site and mode of support.

Methods: The Extracorporeal Life Support Organization (ELSO) registry was queried for all pediatric respiratory failure patients <18 years treated from 1993-2007. The primary outcome was radiographic evidence of CNS injury.

Results: Venoarterial (VA) support was used in 62% of 2617 ECMO runs. The carotid artery was used in 93% of VA patients. Femoral artery use increased in patients >5 years of age and >20 kg. Venovenous (VV) ECMO was used in >50% of children >10 years. No significant difference was identified in CNS injury between carotid and femoral cannulation in any age group but the femoral group was small (4.4%). VA support was independently associated with increased odds of CNS injury compared to VV cannulation (OR, 1.6).

Conclusion: VA ECMO is the most common mode of support in pediatric respiratory failure patients. Although no significant difference in CNS injury was noted between carotid and femoral artery cannulation, the odds of injury were significantly higher than VV support.