Multisite Cannulation for Venovenous Extracorporeal Membrane Oxygenation Support in Neonates and Infants: Extracorporeal Life Support Database Study, 2013-2023.

IF 4.9 2区医学 Q1 CRITICAL CARE MEDICINE

Pediatric Critical Care Medicine Pub Date : 2026-10-01 Epub Date: 2026-07-02 DOI:10.1097/PCC.0000000000004009

Jon Lillie, Shane M Tibby, Peter Rycus, Marc Anders, Gail Annich, Matteo Di Nardo, Geoff Burnhill

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引用次数: 0

Abstract

Objectives: We have evaluated the complications and outcomes of venovenous multisite (VVMS) cannulation for support with extracorporeal membrane oxygenation (ECMO) using the Extracorporeal Life Support Organization (ELSO) registry of neonates (≤ 28 d old) and infants (29-364 d old).

Design: Retrospective ELSO database cohort, comparing outcomes and complications associated with VVMS and venovenous dual lumen (VVDL) cannulation.

Patients: Patients younger than 1 year supported with VV ECMO.

Setting: ELSO data January 1, 2013 to December 31, 2023.

Interventions: None.

Measurements and main results: We identified 1403 neonates and 603 infants supported with VVDL, and 42 and 77, respectively, with VVMS. At 24 hours of ECMO we found median (interquartile range [IQR]) oxygen saturations (Sa o2 ) were higher in the VVMS compared with the VVDL group: for neonates, 98% (IQR, 93-99%) vs. 94% (IQR, 89-97%); a p value of less than 0.01; and for infants, 94% (IQR, 91-97%) vs. 90% (IQR, 85-95%); a p value of less than 0.01. After adjustment for ventilatory parameters, VVMS was associated with higher mean (95% CI) Sa o2 than VVDL: for neonates by 3.3% (95% CI, 1.0-5.6%); p = 0.005; and for infants by 3.3% (95% CI, 1.3-5.3%); p = 0.002. Higher Sa o2 was also associated with higher flows rather than ventilator parameters. Median flows were higher in the VVMS group compared with VVDL for neonates (111 vs. 101 mL/kg/min) and infants (114 vs. 100 mL/kg/min); a p value of less than 0.01. In general, we failed to identify associations between support technique and mortality or complications. However, in infants, VVMS in comparison with VVDL was associated with fewer mechanical complications (23% vs. 37%; p = 0.02).

Conclusions: Between 2013 and 2023, in neonatal and infant ECMO, VVMS as opposed to VVDL cannulation was associated with higher ECMO flows and Sa o2 at 24-hour support. We failed to identify associations between support technique and complications or mortality, apart from lower mechanical complications in infants supported using VVMS.

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新生儿和婴儿静脉-静脉体外膜氧合支持的多点插管：体外生命支持数据库研究，2013-2023。

目的：我们利用体外生命支持组织（ELSO）对新生儿（≤28天）和婴儿（29-364天）进行登记，评估静脉静脉多点（VVMS）插管支持体外膜氧合（ECMO）的并发症和结果。设计：回顾性ELSO数据库队列，比较VVMS和静脉-静脉双腔（VVDL）插管相关的结果和并发症。患者：年龄小于1岁的患者，支持VV ECMO。设置：ELSO数据2013年1月1日至2023年12月31日。干预措施:没有。测量和主要结果：我们确定了1403名新生儿和603名婴儿支持VVDL， 42名和77名支持VVMS。在ECMO 24小时时，我们发现VVMS组的中位数（四分位间距[IQR]）氧饱和度（Sao2）高于VVDL组：新生儿为98% （IQR, 93-99%）对94% (IQR, 89-97%)；p值小于0.01；婴儿为94% (IQR, 91-97%) vs. 90% (IQR, 85-95%)；p值小于0.01。调整通气参数后，VVMS与新生儿的平均Sao2 （95% CI）比VVDL高3.3% (95% CI, 1.0-5.6%)；P = 0.005；婴儿为3.3% (95% CI, 1.3-5.3%)；P = 0.002。较高的Sao2也与较高的流量相关，而不是与呼吸机参数相关。新生儿（111 mL/kg/min vs 101 mL/kg/min）和婴儿（114 mL/kg/min vs 100 mL/kg/min）与VVDL组相比，VVMS组的中位流量更高；p值小于0.01。总的来说，我们未能确定支持技术与死亡率或并发症之间的联系。然而，在婴儿中，与VVDL相比，VVMS与较少的机械并发症相关（23%对37%；p = 0.02）。结论：在2013年至2023年期间，在新生儿和婴儿ECMO中，VVMS与VVDL插管相比，在24小时支持时ECMO流量和Sao2较高。除了使用VVMS支持的婴儿较低的机械并发症外，我们未能确定支持技术与并发症或死亡率之间的关联。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Critical Care Medicine 医学-危重病医学

CiteScore

7.40

自引率

14.60%

发文量

991

审稿时长

3-8 weeks

期刊介绍： Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.