Is peripheral venovenous-arterial ECMO a feasible alternative to central cannulation for pediatric refractory septic shock?
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for the management of neonatal and pediatric refractory septic shock (RSS) is a controversial intervention . A recent international multicenter retrospective study  showed that VA-ECMO was not able to provide a significant survival benefit when compared with standard conventional therapy; however, the use of central, atrio-aortic VA-ECMO cannulation, achieving flow rates > 150 ml/kg/min, was associated with improved survival . High-flow VA-ECMO using a peripheral configuration is often limited in infants and children below 20 kg due to the small size of the peripheral vessels, femoral vessels in particular . On the other side, the central atrio-aortic cannulation represents a challenging approach in centers without cardiothoracic surgery . Therefore, we propose an alternative peripheral “hybrid” configuration using the bidirectional internal jugular venous cannulation , which, in our experience,...
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All authors declare that they have no conflicts of interest.
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