A multidisciplinary approach to VA ECMO cannulation in children

Gleeson, Emile I.; Cunningham, Megan E.; Burgman, Cole; Musick, Matthew; Thomas, James A.; Gardner, Gregory; Kukreja, Kamlesh; Vogel, Adam M.

doi:10.1016/j.jpedsurg.2020.03.001

Cited by 4 publications

(3 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the early phases of ECMO, it has been clinically shown that the initial ischemia status of the lower extremities on the side of femoral artery cannulation naturally improves without DPC intervention. [9][10][11] Due to their condition not rapidly improving following an ECMO procedure, some patients can progressively acquire severe limb ischemia. [12][13][14] Therefore, it is crucial to assess whether DPC implantation is successful in treating or preventing limb ischemia in addition to its efficacy.…”

Section: Discussionmentioning

confidence: 99%

The Preventive Effect of Distal Perfusion Catheters on Vascular Complications in Patients Undergoing Venous Artery Extracorporeal Membrane Oxygenation

Wang¹,

Wang²,

Yang³

et al. 2023

JMDH

View full text Add to dashboard Cite

Objective To investigate the preventive effect of distal perfusion catheters (DPCs) on vascular complications in patients undergoing venous artery extracorporeal membrane oxygenation (VA-ECMO). Methods Patients who underwent VA-ECMO through a femoral approach in our hospital were included in this study, and they were divided into two groups according to their use of DPC. Clinical indicators were compared between the two groups, including the ECMO running time, intensive care unit (ICU) time, length of hospital stay, ECMO auxiliary results, the incidence of limb ischemia and vascular complications. Results In total, 250 patients were included in this study, including the DPC group (age: 48 [32–62] years old, 58.4% male, n = 125) and the non-DPC group (age: 51 [36–63] years old, 65.6% male, n = 125). The DPC group was less likely to have limb complications than the non-DPC group (6.4% vs 17.6%, P = 0.006), mainly resulting from distal ischemia (4.0% vs 15.2%, P = 0.003) and necrosis (1.6% vs 9.6%, P = 0.006). The ECMO duration had a median of 92.3 (75.7–109) h in the DPC group and 71.2 (59.4–82.8) h in the DPC group, with a difference close to the statistical threshold ( P = 0.054). There was no significant difference in ICU time or length of hospital stay between the two groups. The multivariate analysis showed that the DPC implantation was negatively associated with limb complications (odds ratio: 0.265, 95% confidence interval: 0.107–0.657, P = 0.004) after adjustment for confounding factors. Conclusion Distal perfusion catheter placement might be associated with a decreased risk of vascular complications and limb ischemia in patients undergoing femoral VA-ECMO cannulation. Further randomised studies are still needed to verify its benefit on clinical outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

The Preventive Effect of Distal Perfusion Catheters on Vascular Complications in Patients Undergoing Venous Artery Extracorporeal Membrane Oxygenation

Wang¹,

Wang²,

Yang³

et al. 2023

JMDH

View full text Add to dashboard Cite

show abstract

“…Traditionally, VA-ECMO cannulations and decannulations are performed by surgeons via a cutdown technique to isolate and visualize the vessels in which cannulas are placed. 8,13,14 Though double lumen, VV-ECMO, and noncardiac VA-ECMO cannulations are safely performed by nonsurgeon physicians in children, 11,12 the most intense VA-ECMO for cardiogenic shock and during CPR is not performed by pediatric trained physicians. Pediatric interventional cardiologists are proficient with ultrasound-guided vascular access, and with the use of large bore sheaths and delivery systems for several complex, cardiac interventional procedures.…”

Section: Discussionmentioning

confidence: 99%

“…However, the most intense, high‐risk, VA‐ECMO cannulations in children are traditionally performed by surgeons via a standard cutdown technique. Recently, a collaborative approach between interventional radiology and pediatric surgery demonstrated the feasibility of performing percutaneous, noncardiac pediatric VA‐ECMO cannulations 12 . Currently, there is no literature on pediatric cardiac VA‐ECMO cannulation by nonsurgical physicians and none for V‐A ECMO cannulation during CPR in children.…”

Section: Introductionmentioning

confidence: 99%

Strategies and techniques for percutaneous Veno‐Arterial ECMO cannulation and decannulation in children

Buyukgoz

Sandhu

Shah

et al. 2023

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives: To describe the techniques used for percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation and decannulation in children with the pediatric interventional cardiologist (PIC) as the primary operator, and present outcomes of this initial clinical experience.Background: Percutaneous VA-ECMO during cardiopulmonary resuscitation (CPR) has been successfully performed in adults, but currently, not much data exists on children.Methods: This is a single-center study including VA-ECMO cannulations performed by the PIC between 2019 and 2021. Efficacy was defined as the successful initiation of VA-ECMO without surgical cutdown. Safety was defined as the absence of additional procedures related to cannulation.Results: Twenty-three percutaneous VA-ECMO cannulations were performed by PIC on 20 children with 100% success. Fourteen (61%) were performed during ongoing CPR, and nine for cardiogenic shock. The Median age was 15 (0.15-18) years, and the median weight was 65 (3.3-180) kg. All arterial cannulations were via the femoral artery except in one, 8-week-old infant who was cannulated in the carotid artery. A distal perfusion cannula was placed in the ipsilateral limb in 17 (78%). The median time from initiating cannulation to ECMO flow was 35 (13-112) minutes. Two patients required arterial graft placement at the time of decannulation and one needed below-knee amputation. ECMO support was maintained for a median of 4 (0.3-38) days. Thirty-day survival was 74%. Conclusion:Percutaneous VA-ECMO cannulations can be effectively performed, even during CPR with the Pediatric Interventional Cardiologist being the primary operator. This is an initial clinical experience. Future outcome studies compared with standard surgical cannulations are necessary to advocate routine percutaneous VA-ECMO in children.

show abstract