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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
Letter

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,...

Notes

Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflicts of interest.

References

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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

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