Percutaneous, ultrasound‐guided single‐ and multisite cannulation for veno‐venous extracorporeal membrane oxygenation in neonates

Abstract

AimsExtracorporeal membrane oxygenation (ECMO) is a widely used technique to support neonates with severe respiratory failure. Data on percutaneous, ultrasound‐guided veno‐venous (VV) ECMO cannulation in neonates is still scarce. Aim of this study was to describe our institutional experience with ultrasound‐guided percutaneous, VV ECMO cannulation in neonates with severe respiratory failure.MethodsNeonates receiving ECMO support at our department between January 2017 and January 2021 were retrospectively identified. Patients receiving VV ECMO cannulation performed by the percutaneous Seldinger technique by single‐ or multisite cannulation were analyzed.ResultsA total of 54 neonates received ECMO cannulation performed by the percutaneous Seldinger technique. In 39 patients (72%) a 13 French bicaval dual‐lumen cannula was inserted and in 15 patients (28%) two single‐lumen cannulae were used. Cannulae positioning using the multisite approach was in all cases as desired. The tip of the 13 French cannula was located in the IVC in 35/39 patients, in four patients position was too proximal but did not dislocate during the ECMO run. One (2%) preterm neonate (weight 1.75 kg) developed a cardiac tamponade which was successfully managed with drainage. Median duration of ECMO was 7 days (interquartile range: 5–16 days). Forty‐four patients (82%) were successfully weaned from ECMO and in 31/44 (71%) the ECMO cannulae were removed with a delay of 0.9–7.2 days (median 2.8 days) after weaning without noticing complications.ConclusionsA correct cannula placement using the ultrasound‐guided percutaneous Seldinger technique, for both single‐ and multisite cannulation, seems feasible in most neonatal patients receiving VV ECMO.

Applications of Point-of-Care-Ultrasound in Neonatology: A Systematic Review of the Literature

“…For the management of newborns undergoing extracorporeal membrane oxygenation, POCUS aids in evaluating candidacy, guiding cannulation procedures, ensuring correct catheter placement, and detecting and managing complications, including pneumothorax and effusions, by daily monitoring of heart and lung function as well as brain perfusion [ 14 , 75 , 82 , 83 ].…”