Cervical ECMO cannula placement in infants and children: Recommendations for assessment of adequate positioning and function

Irish, Michael S.; O’Toole, Stuart; Kapur, Pierina; Bambini, Daniel A.; Azizkhan, Richard G.; Allen, James E.; Caty, Michael G.; Gilbert, James C.; Steinhorn, Robin H.; Glick, Philip L.

doi:10.1016/s0022-3468(98)90676-5

Cited by 33 publications

(15 citation statements)

References 10 publications

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“…Only more recently has data been presented in the literature to recommend ECHO or fluoroscopy during cannulation to avoid some of these issues. [2][3][4]6 This study set out to assess whether the use of ECHO guidance during neonatal and pediatric jugular cannulation for ECMO reduced the need for cannula repositioning or decreased morbidity. In designing the protocol reported in this study, our goal was to perform ECHO on all ECMO patients during cannulation after initiation of the protocol.…”

Section: Discussionmentioning

confidence: 99%

“…1 As a result, recent literature has encouraged the use of echocardiography (ECHO) as a more accurate means of assessing cannula position by demonstrating that ECHO performed at the time of cannula placement reduces the need for cannula repositioning and may reduce morbidity associated with misplaced cannulae. [2][3][4] Therefore, we set out to decipher the clinical and institutional effect after initiating a protocol encouraging the routine use of ECHO at the time of right internal jugular cannula placement in January 2015. Our primary aim was to determine if ECHO use decreased the need for cannula repositioning during the ECMO run.…”

Section: Introductionmentioning

confidence: 99%

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Echocardiographic Guidance During Neonatal and Pediatric Jugular Cannulation for ECMO

Salazar

Blitzer

Dolejs

et al. 2018

Journal of Surgical Research

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Background: Internal jugular cannula position is traditionally confirmed via plain film at the conclusion of the peripheral ECMO cannulation procedure. However, it may be difficult to estimate the location of the right atrium on plain films. A misplaced cannula can result in need for repositioning and increased morbidity. Echocardiography (ECHO) may be used during cannulation as a more accurate means of guiding cannula position. The aim of this study is to study the effect of a protocol encouraging the routine use of ECHO at the time of cannulation. Objective: To assess whether the use of echocardiographic guidance during neonatal and pediatric jugular cannulation for ECMO reduces the need for cannula repositioning or decreases morbidity. Methods and Materials: We performed a retrospective review of patients at a single institution who received ECMO support using jugular venous cannulation from January 2013 through October 2016. We compared those who underwent ECHO (ECHO+) at the time of cannulation with those who did not (ECHO-). Patient demographics and surgical history, ECMO cannulation details, ECMO events, need for cannula repositioning, cannula related morbidity, and patient outcomes were noted. The results were analyzed with descriptive and non-parametric statistics where applicable. Results: 89 patients met inclusion criteria: 26 ECHO+ (29%), 63 ECHO-(71%). Most of ECHO+ patients underwent dual-lumen VV cannulation (n=17, 65%), while 32% of ECHO-patients had VV support (p<0.003). Seven (27%) ECHO+ patients and 18 (28%) ECHO-patients had a history of cardiac surgery prior to ECMO (p=0.88). All patients had CXR to verify cannula position, and fluoroscopy was used in 4 ECHO+ patients but no ECHO-patients. There was a major mechanical complication in each group: atrial perforation from a guidewire during cannulation in ECHO+ and late atrial perforation from a loose cannula in ECHO-. Subsequent to cannulation, there were 0.58 ECHO studies per patient to verify cannula position in the ECHO+ group compared to 0.22 ECHO per patient in the ECHO-group (p=0.02). Two (8%) ECHO+ patients required a cannula repositioning procedure for misplacement during the ECMO run, while 6 (10%) ECHO-patients required repositioning procedures (p=0.78). In the VV ECMO subgroup, ECHO+ patients required no repositioning, while 4 (20%) of ECHO-VV patients required repositioning (p=0.1). Patients who had ECHO to verify cannula placement during the ECMO run were more likely to have a repositioning procedure (p<0.001). Repositioning procedures resulted in no additional complications. Survival to discharge was similar in both groups: 54% ECHO+ and 62% ECHO-(p=0.51).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Echocardiographic Guidance During Neonatal and Pediatric Jugular Cannulation for ECMO

Salazar

Blitzer

Dolejs

et al. 2018

Journal of Surgical Research

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“…A review of the Extracorporeal Life Support Organization Registry indicated that cannula placement complications with ECMO occurred with a prevalence of 9% 5. Chest X‐ray is not sensitive in demonstrating malpositioned ECMO catheters, and failure to image the catheter with a more sensitive imaging technique (echocardiography, fluoroscopy) often leads to suboptimal flow and a second operation for repositioning of the cannula 6…”

Section: Discussionmentioning

confidence: 99%

Transthoracic echocardiography visualization of bicaval dual lumen catheters for veno‐venous extracorporeal membrane oxygenation

Tabak

Elliott

Mahnke

et al. 2012

J of Clinical Ultrasound

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Bicaval dual lumen catheters improve the efficiency of veno-venous extracorporeal membrane oxygenation by minimizing recirculation with an innovative design, which requires precise placement of three catheter ports in the superior vena cava, right atrium, and inferior vena cava, respectively. However, the exact position of these catheter ports is usually not known during placement because they cannot be visualized with conventional radiography. We performed a retrospective review of our experience over the past year using transthoracic echocardiography to evaluate the position of the catheter ports. From a subcostal, sagittal imaging approach, we were able to identify all three catheter ports in 11 of 11 studies. At least one of the catheter ports was incorrectly positioned in 5 of 11 studies. Further prospective evaluation is necessary to determine if catheter repositioning based on transthoracic echocardiography findings can further improve the clinical efficiency of veno-venous extracorporeal membrane oxygenation.

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“…This particular problem can be diagnosed when an intraoperative echocardiogram cannot visualize a cannula in the SVC or RA despite a normal-appearing anteroposterior chest x-ray. Although chest x-ray is not a sensitive study to define cannula position, a cross-table lateral chest x-ray can help confirm a suspected azygous vein cannulation by demonstrating a posteriorly orientated venous cannula [19] (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

Challenges to cannulation for extracorporeal support in neonates with right-sided congenital diaphragmatic hernia

Fisher¹,

Jefferson²,

Kuenzler

et al. 2007

Journal of Pediatric Surgery

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Cervical ECMO cannula placement in infants and children: Recommendations for assessment of adequate positioning and function

Cited by 33 publications

References 10 publications

Echocardiographic Guidance During Neonatal and Pediatric Jugular Cannulation for ECMO

Echocardiographic Guidance During Neonatal and Pediatric Jugular Cannulation for ECMO

Transthoracic echocardiography visualization of bicaval dual lumen catheters for veno‐venous extracorporeal membrane oxygenation

Challenges to cannulation for extracorporeal support in neonates with right-sided congenital diaphragmatic hernia

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