Impact of drainage cannula type on patients’ fluid balance in venovenous extracorporeal membrane oxygenation: A historical cohort study

<i>Objective</i>: Positive fluid balance in patients on veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with increased mortality. Drainage insufficiency on VV ECMO is a common occurrence and managed with fluid administration. The use of multi-stage drainage cannulas may result in decreased drainage insufficiency, but it is unclear the effects this may have on patient fluid balance.<i>Design</i>: A historical cohort study was conducted on adult patients undergoing VV ECMO for acute respiratory failure in femoral-jugular configuration.<i>Setting</i>: Intensive Care Unit.<i>Patients</i>: Adult patients undergoing VV ECMO for acute respiratory failure.<i>Interventions</i>: Cumulative fluid balance in the first 7 days following initiation of VV ECMO was examined. The relationship between cumulative daily fluid balance over the first 7 days and type of drainage cannula was assessed using mixed methods linear regression.<i>Measurements and Main Results</i>: We included 82 consecutive patients between April 1st, 2020 and September 1st, 2022. 47 (57%) patients were treated with a single-stage drainage cannula. Our final model showed the use of a multi-stage cannula decreased fluid balance by 740 mL/day (95% CI: -1360 to -118, <i>p</i> = .02) compared to patients with a single-stage drainage cannula for the first 7 days.<i>Conclusions</i>: The use of multi-stage drainage cannulas resulted in improved fluid balance in patients on VV ECMO in the first 7 days.