Review
Copyright ©2013 Baishideng Publishing Group Co.
World J Crit Care Med. Nov 4, 2013; 2(4): 29-39
Published online Nov 4, 2013. doi: 10.5492/wjccm.v2.i4.29
Table 1 Extracorporeal membrane oxygenation limitations and advantages comparing veno venous to veno arterial support
FactorsVeno venousVeno arterial
Systemic emboliLower rate unless intra cardiac shunt presentIncreased rate of stroke and seizures with carotid cannulation, risk increases with patient age
Limb ischemia with femoral arterial cannulation
Cardiopulmonary supportDoes not provide direct hemodynamic supportProvides full hemodynamic support
Lower systemic oxygenationHigh systemic oxygenation
Increased rate of hypertension during ECMONon pulsatile flow
Usually requires some degree of pulmonary gas exchange and lung recruitmentMore commonly used with severe air leak
Indirect support with more oxygenated blood provided to pulmonary circulation
Organ injuryLess acute kidney injury- preserved pulsatile blood flowMore acute kidney injury
Less central nervous system injury riskMore central nervous system injury risk
MonitoringMixed venous oxygen saturation less reliable due to recirculationReliable mixed venous saturation measurements
BleedingIncreased cannula site bleedingMore bleeding with multiple site cannulation and femoral arterial cannulation compared to carotid
InfectionLess risk with percutaneous and single cannula useGreater rates of infection
RehabilitationLess sedation use if adequate oxygen delivery possible
Mobilization of patients more feasible with single catheter neck catheter
Table 2 Factors associated with hospital mortality among pediatric patients receiving extracorporeal membrane oxygenation for respiratory failure
FactorsIncreased survivalIncreased death
AgeYoungerAge > 10 yr
Pulmonary processAsthmaPertussis
Viral pneumonia/bronchiolitisSepsis
Aspiration pneumoniaOpportunistic infections
Organ dysfunctionRenal failure/dialysis
Liver injury
Immune impairment/deficiency
Cardiac arrest prior to ECMO
Severity of ventilator associated lung injury prior to ECMOSevere acidosis
High mean airway pressure
Duration ventilation > 14 d
ModeVVVA
Complications during ECMOInfection
Stroke
Cardiac arrest
Organ failure