Purpose:

Complications associated with use of dual-lumen venovenous extracorporeal membrane oxygenation (VV-ECMO) cannulas are of concern in pediatric patients. While the risk of atrial perforation is believed to be higher with bicaval cannulas, direct comparison of complication rate between atrial and bicaval cannulas has not been conducted in this population.

Methods:

A retrospective review was conducted at a free-standing children’s hospital of all patients 0–18 years old, placed on VV-ECMO with a dual-lumen cannula from January 2009 to December 2018. Patients were grouped based on cannula type. Complications were assessed over the entire duration of the ECMO run. Logistic regression analyses were used to evaluate for an association between cannula type and risk of pericardial effusion or cannula-related complication requiring median sternotomy or pericardial drain placement.

Results:

During the study period 119 patients were placed on VVECMO using a dual-lumen cannula. Eighty-two patients (69%) were <2 years old, 19 (16%) were 2–10 years old, and 18 (15%) were 11–18 years old. Seventy-three were cannulated with an atrial cannula and 46 patients received a bicaval cannula. Pericardial effusions were seen in 30% and 24% of these patients respectively while severe complications were seen in 9.6% and 8.7% of patients respectively. Compared to patients treated with a bicaval cannula, those who received an atrial cannula had similar odds of effusions (OR: 1.41, 95% CI: 0.62–3.36) and severe complications (OR 0.89, 95% CI: 0.27–3.18). After adjusting for age, weight, cannula and circuit manipulations, and use of echocardiography, the OR of effusion was 1.91 (95% CI: 0.65–6.42), and the adjusted OR of severe complication was 0.69 (95% CI: 0.16–3.33).

Conclusions:

There were no significant differences in frequency of pericardial effusions or severe cannula-related complications between the treatment groups across all pediatric patients and within the subgroup of patients under 2 years of age.

中文翻译：

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在儿科人群中，心房和双腔双腔静脉-静脉 ECMO 插管之间的心房穿孔频率相似

目的：

与使用双腔静脉体外膜肺氧合 (VV-ECMO) 插管相关的并发症是儿科患者关注的问题。虽然据信使用双心腔插管的心房穿孔风险更高，但尚未在该人群中直接比较心房和双心腔插管的并发症发生率。

方法：

回顾性研究于 2009 年 1 月至 2018 年 12 月在一家独立儿童医院对所有 0-18 岁的患者进行了回顾性研究，这些患者接受了双腔插管的 VV-ECMO。根据插管类型对患者进行分组。在整个 ECMO 运行期间评估并发症。Logistic 回归分析用于评估套管类型与心包积液风险或套管相关并发症（需要胸骨正中切开术或心包引流管放置）之间的关联。

结果：

在研究期间，使用双腔套管将 119 名患者置于 VVECMO 上。82 名患者 (69%) 年龄小于 2 岁，19 名患者 (16%) 年龄在 2-10 岁之间，18 名患者 (15%) 年龄在 11-18 岁之间。73 名患者接受了心房插管，46 名患者接受了双心房插管。这些患者中分别有 30% 和 24% 出现心包积液，而严重并发症分别出现在 9.6% 和 8.7% 的患者中。与接受双心腔插管治疗的患者相比，接受心房插管的患者发生胸腔积液（OR：1.41，95% CI：0.62-3.36）和严重并发症（OR 0.89，95% CI：0.27-3.18）的几率相似。在调整年龄、体重、插管和回路操作以及使用超声心动图后，积液的 OR 为 1.91（95% CI：0.65-6.42），调整后的严重并发症 OR 为 0。

结论：

在所有儿科患者和 2 岁以下患者亚组内，治疗组之间的心包积液或严重插管相关并发症的频率没有显着差异。