Intensive Care Medicine

, Volume 45, Issue 11, pp 1658–1660 | Cite as

Is peripheral venovenous-arterial ECMO a feasible alternative to central cannulation for pediatric refractory septic shock?

  • G. C. van Leeuwen Bichara
  • B. Furlanetto
  • L. Gondim Teixeira
  • M. Di NardoEmail author

Dear Editor,

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for the management of neonatal and pediatric refractory septic shock (RSS) is a controversial intervention [1]. A recent international multicenter retrospective study [2] 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 [2]. 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 [3]. On the other side, the central atrio-aortic cannulation represents a challenging approach in centers without cardiothoracic surgery [3]. Therefore, we propose an alternative peripheral “hybrid” configuration using the bidirectional internal jugular venous cannulation [4], which, in our experience,...


Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflicts of interest.


  1. 1.
    Davis AL, Carcillo JA, Aneja RK, Deymann AJ, Lin JC, Nguyen TC et al (2017) American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med 45(6):1061–1093CrossRefPubMedGoogle Scholar
  2. 2.
    Oberender F, Ganeshalingham A, Fortenberry JD, Hobson MJ, Houmes RJ, Morris KP, Numa A, Hoq MM, Donath S, Beca J, Butt W (2018) Venoarterial extracorporeal membrane oxygenation Versus conventional therapy in severe pediatric septic shock. Pediatr Crit Care Med 19(10):965–972CrossRefPubMedGoogle Scholar
  3. 3.
    MacLaren G, Butt W, Best D, Donath S (2011) Central extracorporeal membrane oxygenation for refractory pediatric septic shock. Pediatr Crit Care Med 12(2):133–136CrossRefPubMedGoogle Scholar
  4. 4.
    Skarsgard ED, Salt DR, Lee SK (2004) Venovenous extracorporeal membrane oxygenation in neonatal respiratory failure: does routine, cephalad jugular drainage improve outcome? J Pediatr Surg 39(5):672–676CrossRefPubMedGoogle Scholar
  5. 5.
    Morin L, Ray S, Wilson C, Remy S, Benissa MR, Jansen NJG, Javouhey E, Peters MJ, Kneyber M, De Luca D, Nadel S, Schlapbach LJ, Maclaren G, Tissieres P, ESPNIC Refractory Septic Shock Definition Taskforce the Infection Systemic Inflammation Sepsis section of ESPNIC (2016) Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition. Intensive Care Med 42(12):1948–1957CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • G. C. van Leeuwen Bichara
    • 1
  • B. Furlanetto
    • 2
  • L. Gondim Teixeira
    • 1
  • M. Di Nardo
    • 3
    Email author
  1. 1.Pediatric Cardiac Intensive Care UnitChildren’s Hospital SabaraSao PauloBrazil
  2. 2.Pediatric Cardiac Surgery UnitChildren’s Hospital SabaraSao PauloBrazil
  3. 3.Pediatric Critical Care Medicine, Pediatric Intensive Care UnitChildren’s Hospital Bambino GesùRomeItaly

Personalised recommendations