Comparing outcomes of venovenous versus venoarterial extracorporeal membrane oxygenation in neonatal and pediatric respiratory failure: A retrospective review of Extracorporeal Life Support Organization registry

Background: The ideal extracorporeal membrane oxygenation (ECMO) modality choice (venoarterial [VA] versus venovenous [VV]) for a primary respiratory reason is complex and multifactorial. There is an increasing need to identify the ideal (VV vs. VA) support modality in this population. The objective of this study was to compare survival outcomes of subjects with respiratory failure who could have received VV or VA ECMO. Subjects and Methods: Children ≤20 kg requiring ECMO for respiratory indications from January 2015 to December 2019 were identified retrospectively from the Extracorporeal Life Support Organization registry. To identify a cohort eligible for VV, we excluded subjects receiving cardiac support therapies and included only those receiving mechanical ventilation with a positive end expiratory pressure ≥10 or high frequency oscillatory ventilation or had a PaO2/FiO2 ratio ≤200 or an oxygenation index ≥16. Subjects were grouped by initial cannulation strategy. Statistical approach utilized doubly robust propensity weighted logistic regression and primary outcome was survival to hospital discharge. Results: Of 1686 VV candidates, 871 underwent VV and 815 VA ECMO for a respiratory indication. VV ECMO was associated with higher survival (odds ratio: 1.57; confidence interval: 1.22–2.03, P < 0.001). Conclusions: VV ECMO selection for subjects with respiratory failure was associated with lower mortality in small pediatric and neonatal patients.