PM1052: Market Forces Decreased Venovenous ECMO Usage in Neonates and Older Children

Background: Dual-lumen cannulas for venovenous (VV)-ECMO in pediatric patients allow for single-site cannulation while accommodating pediatric vasculature and minimizing risks. The popular OriGen dual-lumen right atrial cannula was discontinued in 2019 without a comparable replacement.

Methods: A survey covering VV-ECMO practice patterns and opinions was distributed to all attending-staff members of the American Pediatric Surgical Association (APSA).

Results: 137 pediatric surgeons responded (14%). Prior to discontinuation of the OriGen, 82.5% of surgeons offered VV-ECMO to neonates, and 79.6% cannulated with the OriGen. Following its discontinuation, the number of surgeons that offered only venoarterial (VA)-ECMO to neonates increased to 36.7% from 17.5% (p=0.0006). An additional 33.1% changed their practice to sometimes use VA-ECMO when VV-ECMO was indicated. Reasons for not incorporating dual-lumen bi-caval cannulation into practice included risk of cardiac injury (50.6%), recirculation and/or positioning problems (27.6%), increased difficulty with placement (31.0%), and inexperience with bi-caval cannulation in neonates (36.8%). For the pediatric/adolescent population, 95.5% of surgeons offered VV-ECMO prior to OriGen discontinuation. After its removal from the market, few changed to exclusive VA-ECMO (1.8%), but 17.3% of surgeons began to incorporate selective use of VA-ECMO. Surgeons in practice longer increasingly preferred the OriGen for pediatric/adolescent patients (p=0.0185) and trended towards being more likely to consider VA-ECMO (Table 1).

Conclusion: Market changes drove pediatric surgeons to dramatically alter their cannulation practices, significantly increasing VA-ECMO use for neonatal and pediatric respiratory failure. These data demonstrate dependence of specialty practices on industry and suggest a need for targeted education accompanying major technological shifts.