Venovenous perfusion in ECMO for newborn XXXX . A clinical comparison with venoarterial perfusion.

@entity1 @entity1576
Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) has been successful in the treatment of newborns less than 1 week of age and greater than 2000 gm birthweight with @entity1576 resistant to current medical and surgical management. While VA ECMO supports the heart as well as the lungs, it has the disadvantage of requiring carotid artery ligation and the possibility of perfusing air bubbles or particles into the arterial tree. We have treated 11 newborns with @entity1576 with venovenous (VV) ECMO returning the oxygenated blood to a cannula in the distal iliac vein. We compared these @entity1 with 16 @entity1 treated during the same period of time with VA ECMO. Three of the 11 VV @entity1 required conversion to VA ECMO because of inadequate oxygenation and unstable hemodynamic situations. Ten of the 11 VV @entity1 survived. Eleven of the 16 VA @entity1 survived. The better survival in these @entity1 treated with VV ECMO is attributed to their more favorable initial condition compared to @entity1 treated with VA ECMO. The disadvantages of VV ECMO include a longer operative time to place the cannulas, groin wound problems, and persistent leg swelling along with the necessity to convert some @entity1 to VA ECMO. Although this experience demonstrates that newborns with severe @entity1576 can be supported with VV ECMO, the complications and lack of practical advantages over VA lead us to recommend VA ECMO for routine clinical use at present.
