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Bi-caval Dual Lumen Vs Single Site Cannulation For Ecls
Bryan A. Whitson, Shayln Bennett, Ahmet Kilic, Antolin Flores, Thomas Papadimos, Don Hayes, Jr., Ravi Tripathi.
The Ohio State University, Columbus, OH, USA.
OBJECTIVE: Severe acute respiratory failure has a mortality rate of 40 to 60%. Venovenous extracorporeal membrane oxygenation (VV-ECMO) has emerged as an increasingly popular treatment modality showing a significant survival benefit for acute respiratory failure as compared to traditional ventilatory methods.We sought to evaluate the new generation bi-caval dual-lumen cannulas (BCDLC) effect on increased survival and decreased length of stay, as compared to single-lumen cannulation.
METHODS: A prospectively maintained, institutionaldatabase of all patients undergoing VV-ECMO from January, 2012 through May, 2014 was retrospectively reviewed. Those patients who had respiratory failure associated with cardiac surgery or those converted from venoarterial (VA) ECMO to VV-ECMO were excluded.
RESULTS: During the time period reviewed, 29 patients underwent VV-ECMO with 25 patients meeting inclusion criteria. was used in 12/25 (48%) patients. There were no significant differences in age or gender between the two groups. The BCDLC cohort had a lower mean number of days on ECMO 12.33 compared to 16.54 in the single-lumen group, (p=0.299). Mean length of stay was 26.33 days for BCDLC cohort compared to 31.69 in single-lumen group, (p=0.260). Survival to decannulation was 11/12 (91.67%) of BCDLC cohort compared to 8/13 (61.54%) in the single-lumen group, (p=0.087). Survival to discharge was 9/12 (75%) for BCDLC and 8/13 (61.54%) for single-lumen groups, (p=0.387). Early or concomitant tracheostomy was performed in 7/12 (58.33%) of BCDLC group as compared to 2/13 (15.38%) of single-lumen with p=0.034. During the time period reviewed there was only one complication, right atrial perforation, from dual-lumen cannula insertion thus our incidence of right heart cavity perforation 1/12 (8.3%) was consistent with the 4-15% incidence reported in the literature.
CONCLUSIONS: BCDLC is showing better outcomes in terms ECMO duration, length of stay, and survival to decannulation. This warrants further comparison of these two groups as well as further data collection pertaining to differences in sedation and mobility. Further efforts need to be made to achieve early mobilization in our adult population as the ambulatory ECMO technology evolves. <!--EndFragment-->
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