Michael E. DeBakey Department of Surgery, Texas Children's Hospital Fetal Center, Baylor College of Medicine, Houston, TX, USA.
Pediatr Crit Care Med. 2013 May;14(4):366-73. doi: 10.1097/PCC.0b013e31828a70dc.
Venovenous extracorporeal membrane oxygenation has been used to provide cardiopulmonary support in critically ill infants and children. Recently, dual-lumen venovenous extracorporeal membrane oxygenation has gained popularity in the pediatric population. Herein, we report our institutional experience using a bicaval dual-lumen catheter for pediatric venovenous extracorporeal membrane oxygenation support, which has been our unified approach for venovenous extracorporeal membrane oxygenation since 2009.
This study is a retrospective review.
The setting is a tertiary children's hospital in a major metropolitan area.
Between 2009 and 2011, 11 patients were cannulated using a dual-lumen bicaval venous catheter. Patient demographics, cannulation details, circuit complications, complications of catheter use, and patient outcomes were collected from a retrospective chart review.
None.
Eleven of the patients were cannulated for venovenous extracorporeal membrane oxygenation using the dual-lumen bicaval cannula. The median age at the time of venovenous cannulation was 1.9 years (range, 0.14-17.1), and the median weight was 10.2 kg (range, 3-84). Three patients (27%) required conversion to venoarterial extracorporeal membrane oxygenation. The median duration of extracorporeal membrane oxygenation support was 10 days (2-38 days). Fifty-five percent of patients suffered from a bleeding complication (disseminated intravascular coagulation, pulmonary hemorrhage, or intraventricular hemorrhage), and 45% had a circuit complication. Adequate flow rates were achieved in all patients. The overall hospital mortality in the series was 55%. There were no cannula-related complications.
This review presents the first single-institution experience with the dual-lumen Avalon cannula in pediatric patients. Preliminary results indicate that the catheter can be safely placed and has an acceptable complication profile; however, continued study within larger trials is necessary to fully ascertain the clinical profile of this catheter.
静脉-静脉体外膜肺氧合（venovenous extracorporeal membrane oxygenation，VV-ECMO）已被用于为危重症婴儿和儿童提供心肺支持。最近，双腔静脉-静脉体外膜肺氧合（dual-lumen venovenous extracorporeal membrane oxygenation，DL-VV-ECMO）在儿科人群中越来越受欢迎。在此，我们报告了我院自 2009 年以来使用双腔静脉导管进行小儿 VV-ECMO 支持的经验，这是我们进行 VV-ECMO 的统一方法。
本研究为回顾性研究。
三级儿童医院，位于大都市区。
2009 年至 2011 年期间，11 例患者使用双腔双腔静脉导管进行了置管。通过回顾性图表审查收集患者人口统计学、置管细节、回路并发症、导管使用并发症和患者结局的数据。
无。
11 例患者因 VV-ECMO 使用双腔双腔导管进行置管。VV 置管时的中位年龄为 1.9 岁（范围，0.14-17.1），中位体重为 10.2kg（范围，3-84）。3 例（27%）需要转换为静脉-动脉体外膜肺氧合。ECMO 支持的中位时间为 10 天（2-38 天）。55%的患者发生出血并发症（弥漫性血管内凝血、肺出血或脑室出血），45%的患者发生回路并发症。所有患者均实现了足够的流量。该系列的总体院内死亡率为 55%。无导管相关并发症。
本回顾性研究报告了首例在儿科患者中使用双腔 Avalon 导管的单中心经验。初步结果表明，该导管可以安全放置，并发症发生率可接受；然而，需要在更大的试验中进行进一步研究，以充分确定该导管的临床特征。
