Intensivists Performed Percutaneous Bicaval Double-Lumen Echo-Guided Extracorporeal Membrane Oxygenation Cannulation at Bedside in Newborns and Children: A Retrospective Analysis

Abstract

Objectives: To describe a single institution experience on echo-guided percutaneous bicaval double lumen extracorporeal membrane oxygenation cannulation performed at the bedside by intensivists. Design: Retrospective observational study. Setting: Extracorporeal membrane oxygenation team of a tertiary care children’s hospital. Patients: All patients 0–14 years old undergoing venovenous extracorporeal membrane oxygenation from January 1, 2013, to January 1, 2018. Interventions: None. Measurements and Main Results: Thirty children underwent 32 extracorporeal membrane oxygenation runs. Median age at enrollment was 2 months (interquartile range, 0–20.5 mo), 65.6% of the runs (21 patients) were performed in newborns (n = 13, 40.6%) or infants (n = 8, 25%). Median preextracorporeal membrane oxygenation index was 66.9 (interquartile range, 50–85.6). Major comorbidities were present in 50% of patients. All patients were cannulated percutaneously. In two cases cannulation occurred from the left internal jugular vein. Extracorporeal membrane oxygenation was effective in increasing pH, arterial oxygen saturation, Pao 2, and lowering Paco 2. The overall differences in pre and postextracorporeal membrane oxygenation values were statistically significant, while stratifying patients according to the cannula diameter (mm)/major diameter of the cannulated internal jugular vein (mm) ratio (> 0.67 or ≤ 0.67), statistical significance was reached only for the highest ratio. Complications were observed in three runs: two cannula tip dislocations in the right atrium and one limited flow in the only case in which an Avalon cannula was not used. In 20 cases (62.5% of 32 runs), the cannulated vessel was patent at follow-up or autopsy. A ratio less than or equal to 0.67 or greater than 0.67 did not influence the occurrence rate of complications, nonpatency of the internal jugular vein, death for intracranial bleeding and death at 30 days from extracorporeal membrane oxygenation discontinuation. Overall cumulative survival at 30 days from extracorporeal membrane oxygenation discontinuation was 60% (95% CI, 40–75), with a survival advantage in the case of ratio greater than 0.67 (65%; 95% CI, 44–80 vs 25%; 95% CI, 0–60). Conclusions: The described technique proved to be feasible, safe, and effective. Further investigation is needed.

Pediatric patients requiring extracorporeal membrane oxygenation in heart failure: 30‐day outcomes; mid‐ and long‐term survival. A single center experience

“…Similar to our results, Moscatelli also did not find any cannulation‐related differences between groups, whereas Zaleski et al depicted that central ECMO cannulation in high‐risk pediatric cardiac procedures increased survival rates of patients, but it should be noted as stated by Garcia et al that consensus on pediatric cannulation strategies and management does not currently exist …”

Delivery Room Intensive Care Unit: 5 Years' Experience in Assistance of High-Risk Newborns at a Referral Center

“…In one case of PAIVS and prenatal closure of DA, emergency veno-venous ECMO support with echoguided percutaneous bicaval double-lumen cannulation was established in the DR in 20 min. The technique was recently described by our group ( 8 ). This approach was defined because parents did not consent for EXIT.…”

COVID-19 Pneumomediastinum: Possible Role of Transesophageal Echo in Bedside Percutaneous Bicaval Double-Lumen ECMO Cannulation in Children. A Case Report

“…Third, it is possible to optimize resource utilization in intensive care units overwhelmed by the burden of patients needing intensive care. This case report shows the feasibility of echo-guided bedside percutaneous BCDL cannulation in children when the absence of a transthoracic window requires transesophageal echo (TEE) control ( 3 ). In accordance with the European Union GDPR, informed consent has been asked from parents for the treatment of patient's data and images, including for scientific purposes.…”

“…In such cases, veno-venous ECMO should be the preferred modality for respiratory support, often representing an effective bridge to recovery. Bicaval double-lumen (BCDL) cannulation might be highly challenging because severe ALS can compromise the acoustic window needed for transthoracic echo (TTE) guidance at the bedside ( 3 ). For several reasons, bedside ECMO cannulation represents an invaluable option in the context of the COVID-19 pandemic.…”