M. L. Kovler1, A. V. Garcia1, J. H. Salazar2, J. Weller1, J. Vacek3, B. T. Many3, Y. Rizeq3, F. Abdullah3, S. D. Goldstein3 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA 2Children’s Hospital Of Wisconsin,Milwaukee, WI, USA 3Lurie Children’s Hospital,Chicago, IL, USA
Introduction:
Venovenous (VV) extracorporeal membrane oxygenation (ECMO) does not provide circulatory augmentation, unlike venoarterial (VA) cannulation. There is an increasing national trend towards initial VV support for noncardiac disease; however, some proportion of children initiated on VV ECMO will ultimately require conversion to VA for persistent hemodynamic instability. The purpose of this work is to perform a descriptive analysis of patients who were converted from VV to VA ECMO.
Methods:
Data on neonates and children who underwent VV-VA ECMO conversion were extracted from the Extracorporeal Life Support Organization (ELSO) registry. Comparisons to VV and VA cannulations without conversion were made from contemporary ELSO International Summary reports.
Results:
This study cohort consisted of 1,382 ECMO patients, comprising 2.5% of pediatric registry entries. The hospital survival rate for neonates denoted as primary respiratory support requiring conversion was 62%, compared to 83% for unconverted VV ECMO and 71% for unconverted VA ECMO. Similarly, the survival of older children requiring conversion was 47% compared to 62% and 52%, respectively.
Conclusion:
VV to VA conversion does occur and is associated with increased mortality. The need for conversion from VV to VA ECMO may represent an early failure to recognize physiologic parameters or disease severity that would be better managed with initial VA support. The delay in circulatory support could be a factor contributing to this cohort’s decreased survival compared to both VV and VA cannulations not requiring conversion. Further research is needed to determine predictors of VV failure so initial ECMO mode selection can be improved.