Neonates with congenital diaphragmatic hernia have smaller neck veins than other neonates-An alternative route for ECMO cannulation

Background/purpose: The aim of this study was to compare the size of the right internal jugular vein between neonates with congenital diaphragmatic hernia (CDH) who need extracorporeal membrane oxygenation (ECMO) and non-CDH neonates. The purpose also was to describe a method for cannulation of the right brachiocephalic vein if the internal jugular vein was too small for ECMO cannulation.

Methods: Birth weight and size of the right internal jugular vein were compared between CDH and non-CDH neonates subjected to ECMO treatment. A corrected venous size was calculated, estimating the venous size if the patient's birth weight was 3,000 g.

Results: The mean birth weight of the CDH patients (3,214 g) was lower than that of the non-CDH patients (3,497 g; P <.04). The mean venous size of the CDH patients (12.1 Charierre [Ch]) was significantly smaller (P <<.001) than that of non CDH patients (13.6 Ch). The corrected venous size also was significantly (P <.001) smaller among CDH patients.

Conclusions: Severely affected neonates with CDH have significantly smaller right internal jugular veins than other neonates. If the patient needs ECMO and if the internal jugular vein is too small for cannulation, the right brachiocephalic vein can be successfully cannulated from the neck instead.