Pediatrik hastalarda ekstrakorporeal membran oksijenasyonu: Tek damar kanülasyonu deneyimimiz

Amaç: Bu çalışmada şiddetli solunum yetmezliği olan çocuklarda bikaval, çift lümen, venovenöz ekstrakorporeal membran oksijenasyonuna ilişkin deneyimimiz sunuldu. Çalışma planı: Eylül 2015 - Mayıs 2019 tarihleri arasında şiddetli solunum yetmezliği nedeniyle pediatrik yoğun bakım ünitesinde yatmakta olan ve bikaval, çift lümen, venovenöz kateter ile kanüle edilen toplam dokuz pediatrik hasta (7 erkek, 2 kız; medyan yaş: 3.1 yıl; dağılım, 0.3-7.4 yıl) retrospektif olarak incelendi. Hastaların demografik özellikleri, kanülasyon detayları, kateter kullanım komplikasyonları ve sonuçları kaydedildi. Bulgular: Medyan ekstrakorporeal membran oksijenasyon desteği süresi dokuz (dağılım, 2-32) gün idi. Bir hastada venoarteriyel ekstrakorporeal membran oksijenasyonuna geçiş, bir hastada ise konvansiyonel çift kanüllü venovenöz ekstrakorporeal membran oksijenasyonuna geçiş gerekti. Hastaların %33’ünde kanama komplikasyonu gelişti. Kanül veya devre ile ilişkili komplikasyon gözlenmedi. Biri hariç, tüm hastalarda yeterli oksijenasyon ve akıma ulaşıldı. Kullanılan kanülasyon tekniği ile doğrudan ilişkili mortalite görülmedi. Sonuç: Bikaval, çift lümen kanül, pediatrik hastalarda minimum komplikasyon oranları ile güvenle kullanılabilir ve venovenöz ekstrakorporeal membran oksijenasyon desteği olarak bizim tercih ettiğimiz bir yöntemdir.

Pediatric extracorporeal membrane oxygenation: Our experience with single-vessel cannulation

Background: In this study, we present our experience withbicaval, dual-lumen, venovenous extracorporeal membraneoxygenation in pediatric patients with severe respiratory failure.Methods: Between September 2015 and May 2019, a total ofnine pediatric patients (7 males, 2 females; median age 3.1 years;range, 0.3 to 7.4 years) hospitalized in the pediatric intensive careunit due to severe respiratory failure who were cannulated usinga bicaval, dual-lumen, venovenous catheter were retrospectivelyanalyzed. Patient demographics, cannulation details, complicationof catheter use, and outcomes were recorded.Results: The median duration of extracorporeal membraneoxygenation support was nine (range, 2 to 32) days. Onepatient required conversion to venoarterial extracorporealmembrane oxygenation and one patient required conversionto conventional double-cannulated venovenous extracorporealmembrane oxygenation. Of the patients, 33% suffered frombleeding complications. There were no cannula- or circuit-relatedcomplications. Adequate oxygenation and flow were obtained inall patients, except one. No mortalities were directly associatedwith the cannulation strategy used.Conclusion: The bicaval, dual-lumen cannula can be safely usedin pediatric patients with minimal complication rates and isour preferred method for venovenous extracorporeal membraneoxygenation support.

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