Extracorporeal Membrane Oxygenation Cannulation Trends for Pediatric Respiratory Failure and Central Nervous System Injury

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 b18 years treated from 1993-2007. The primary outcome was radiographic

evidence of CNS injury.

Results:

Venoarterial (VA) supportwas used in 62%of 2617 ECMOruns. The carotid artery was used in 93%

ofVApatients. Femoral artery use increased in patients N5 years of age and N20 kg. Venovenous (VV)ECMO

was used in N50% of children N10 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.