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

Fisher, Jason C.; Jefferson, Rashida A.; Kuenzler, Keith A.; Stolar, Charles J.H.; Arkovitz, Marc S.

doi:10.1016/j.jpedsurg.2007.08.007

Cited by 21 publications

(15 citation statements)

References 22 publications

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“…A special mention has to be given to one of the potential complications in the right CDH newborns. As described in a previous paper (16), misplacements of the venous cannulas were also recorded in group 2, with the tip located at the confluence of the azygous vein with the Superior Vena Cava (SVC).…”

Section: Discussionmentioning

confidence: 99%

Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

et al. 2019

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Introduction: The surgical technique for peripheral cannulation aimed at providing extracorporeal membrane oxygenation (ECMO) is well described. Training methods for surgeons still need proper standardization, especially in newborn patients. This study aims to evaluate the surgical training outcomes of a neonatal ECMO team.Materials and Methods: A 4 year training program (2014–2018) was developed to achieve the skills in the surgical technique for neonatal veno-arterial ECMO. Surgeons with experience in neonatal and vascular surgery were selected for the training. The training consisted of educational sessions, high-fidelity simulations, in vivo swine model procedures, international fellowship, and periodical simulations. The preliminary clinical experience in surgical neonatal ECMO management (2016-present) was analyzed by recording the following data: indications for ECMO and patients' data; effectiveness of cannulations (number; perioperative complications of cannulation; major surgical events during ECMO); efficacy of decannulation (number and perioperative complications).Results: 12 neonates (5 females) fitted the ELSO criteria for ECMO. Nine newborns were affected by CDH; 1 by H1N1 flu-related pneumonia; 1 by meconium aspiration syndrome and one by Respiratory Syncytial Virus related bronchiolitis. Mean weight at cannulation was 3,281 g (range 2,330–3,840 g); mean gestational age was 36 weeks. No procedure was aborted, and no intra-operatory mortality was recorded. Mean operative time was 86 ± 30 min. The caliber of the carotideal cannulas ranged from 8F (8 patients) to 10F (2 patients); the caliber of the jugular cannulas were: 8F cannula (2 patients), 10F (6 patients), and 12F (2 patients). Four complications occurred: a case of air in the circuit, two cases of azygous vein cannulation and a partial dislocation of the venous cannula during the daily care maneuvers. All of them were promptly recognized and successfully treated. The mean ECMO duration was 7.1 ± 4.2 days (range 2–16 days). Seven patients (78%) were decannulated effectively. Mean decannulation time was 53 min (range 45–80 min). No complications occurred during the decannulation process. No ECMO–related deaths were recorded.Conclusions: Neonatal respiratory ECMO still represents a challenge. Experienced neonatal surgeons can manage the neck vascular cannulation. The codified procedure must be adhered to after appropriate training and following a proper learning curve.

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Section: Discussionmentioning

confidence: 99%

Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

et al. 2019

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“…In 1 prior study, ECMO was used more frequently in R-CDH than in L-CDH [9]. Anatomical distortion unique to R-CDH has been reported to complicate ECMO in some patients [15]. To assess the treatment strategies and outcomes of R-CDH at our institution, particularly in their relation to ECMO, we reviewed the cases of patients diagnosed with R-CDH between 1991 and 2006.…”

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confidence: 99%

Right-sided congenital diaphragmatic hernia: high utilization of extracorporeal membrane oxygenation and high survival

Bryner

Kim

Khouri

et al. 2009

Journal of Pediatric Surgery

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“…To the best of our knowledge, only a few neonatal cases have been previously described in the literature (7–11). Fisher et al described two patients with right-sided CDH (9). In right-sided CDH, erroneous azygos vein cannulation can occur because of geometrical anomalies caused by right-sided CDH itself (9).…”

Section: Discussionmentioning

confidence: 99%

Successful Extracorporeal Membrane Oxygenation After Incidental Azygos Vein Cannulation in a Neonate With Right-Sided Congenital Diaphragmatic Hernia Interruption of the Inferior Vena Cava and Azygos Continuation

et al. 2019

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Incidental azygos vein cannulation has been reported in a few cases of neonatal extracorporeal membrane oxygenation (ECMO). This complication is described in the literature mainly in pathological conditions wherein increased central venous pressure dilates the superior vena cava (SVC), i.e., right congenital diaphragmatic hernia (CDH) or pulmonary hypertension. Azygos vein cannulation should always be suspected in cases of impaired venous return and circuit failure. Although rare, it hinders proper venous aspiration of the ECMO circuit and generally requires repositioning or replacement of the venous cannula or conversion to central cannulation. In this report, we describe a newborn with severe right CDH who required ECMO assistance, wherein incidental cannulation of the azygos vein resulted in successful functioning of the circuit because of the concomitant presence of isolated interruption of the inferior vena cava and azygos continuation. To the best of our knowledge, this is the first report of successful neonatal ECMO despite azygos vein cannulation in a patient with such rare physiology.

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

Cited by 21 publications

References 22 publications

Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

Right-sided congenital diaphragmatic hernia: high utilization of extracorporeal membrane oxygenation and high survival

Successful Extracorporeal Membrane Oxygenation After Incidental Azygos Vein Cannulation in a Neonate With Right-Sided Congenital Diaphragmatic Hernia Interruption of the Inferior Vena Cava and Azygos Continuation

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