Hybrid extracorporeal membrane oxynegation in pediatric intensive care patients: A single center experience: More is better?

• Published in: Perfusion Vol. 39; no. 5; pp. 902 - 910
• Main Authors: Kahveci, Fevzi, Coşkun, Mert Kaan, Uçmak, Hacer, Özen, Hasan, Gurbanov, Anar, Balaban, Burak, Dikmen, Nur, Karagözlü, Selen, Sarıcaoğlu, Mehmet Cahit, Botan, Edin, Gün, Emrah, Havan, Merve, Ramoğlu, Mehmet Gökhan, Uçar, Tayfun, Eyileten, Zeynep, Tutar, Ercan, Akar, Ahmet Rüçhan, Kendirli, Tanıl
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-07-2024; Sage Publications Ltd
• Subjects: Adolescent; Child; Child, Preschool; Critical Care - methods; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - methods; Female; Hospitals; Humans; Hybrid systems; Infant; Intensive Care Units, Pediatric; Male; Membranes; Mortality; Oxygenation; Patients; Pediatrics; Retrospective Studies; Statistical analysis; hybrid ECMO; extracorporeal membrane oxygenation; children; pediatric intensive care
• ISSN: 0267-6591; 1477-111X; 1477-111X
• DOI: 10.1177/02676591231168537

Background
The initial extracorporeal membrane oxygenation (ECMO) configuration is inefficient for patient oxygenation and flow, but by adding a Y-connector, a third or fourth cannula can be used to support the system, which is called hybrid ECMO.
Methods
This was a single-center retrospective study consisting of patients receiving hybrid and standard ECMO in our PICU between January 2014 and January 2022.
Results
The median age of the 12 patients who received hybrid ECMO and were followed up with hybrid ECMO was 140 (range, 82-213) months. The total median ECMO duration of the patients who received hybrid ECMO was 23 (8-72) days, and the median follow-up time on hybrid ECMO was 18 (range, 3-46) days. The mean duration of follow-up in the PICU was 34 (range, 14-184) days. PICU length of stay was found to be statistically significant and was found to be longer in the hybrid ECMO group (p = 0.01). Eight (67%) patients died during follow-up with ECMO. Twenty-eight-day mortality was found to be statistically significant and was found to be higher in the standard ECMO group (p = 0.03). The hybrid ECMO mortality rate was 66% (decannulation from ECMO). The hybrid ECMO hospital mortality rate was 75%. The standard ECMO mortality rate was 52% (decannulation from ECMO). The standard ECMO hospital mortality rate was 65%.
Conclusions
Even though hybrid ECMO use is rare, with increasing experience and new methods, more successful experience will be gained. Switching to hybrid ECMO from standard ECMO at the right time with the right technique can increase treatment success and survival.