J Perinatol

. 2022 Sep 8.

 doi: 10.1038/s41372-022-01503-5. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/36076033/

Cannulation approach and mortality in neonatal ECMO

Jessica L Gancar ¹, Molly C Shields ¹, K Christian Walters ², Linda Wise ¹, Jennifer L Waller ³, Brian K Stansfield ⁴

Affiliations expand

• PMID: 36076033
• DOI: 10.1038/s41372-022-01503-5

Abstract

Objective: Identify associations between cannulation approach and mortality in neonates who received ECMO support for respiratory failure.

Study design: A retrospective analysis of neonates receiving ECMO for respiratory indications at a single quaternary-referral NICU. Associations between cannulation approach and mortality were assessed after adjustment for Neo-RESCUERS score. Cox Proportional Hazards (CPH) model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for each variable and outcome.

Results: Among 244 neonates, overall survival was 88%, with 71% undergoing VV cannulation. After adjusting for Neo-RESCUERS score, VA cannulation was associated with higher mortality during ECMO when compared with VV cannulation (HR 4.189, 95% CI 1.480-11.851, P = 0.0069). Disease-specific comparisons revealed no statistical difference in Neo-RESCUERS score between VA and VV cohorts; however, VA cannulation was associated with higher ECMO mortality for neonates with congenital diaphragmatic hernia (50% vs. 5.5%, Χ² = 8.5965, P = 0.0034) and PPHN (20% vs. 1.8%, Χ² = 9.1047, P = 0.0025) when compared with VV cannulation.

Conclusion: VA cannulation was associated with increased mortality in neonates while on ECMO for respiratory failure, which was independent of illness severity.

© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.