Sonographically guided cannula positioning for extracorporeal membrane oxygenation

Abstract

Drainage problems due to catheter malpositioning are acutely life-threatening in patients undergoing extracorporeal membrane oxygenation. In order to reduce these complications we introduced sonographically guided catheter positioning. We compare the outcome in a group of patients with blind cannula positioning to that in a group with sonographically guided catheter positioning. Our results show that neonates and young infants especially are at high risk of drainage problems due to catheter malposition and that their outcome could be markedly improved by introducing sonographically guided cannula insertion.

Venous thrombosis in and after extracorporeal membrane oxygenation: detection and follow-up by color Doppler sonography

“…Sonography has proved to be an adequate tool for monitoring babies and infants on and after ECMO [5,6,11,13,14,16]. The arterial access using the rCCA has been suspected to result in a higher incidence of right-sided brain lesions during ECMO [17].…”

“…Although there are reports on successful reconstructions of the right jugular vein, we usually ligated the vessel. Color Doppler sonography is proposed for assessment and followup after reconstruction procedures [6,8,9,14]. Furthermore, sonography has been successfully applied to evaluate vascular lesions after central venous catheters [18].…”

“…For tubing, we used 8-to 14-F singlelumen catheters (Biomedicus-Medtronic-Bio-Medicus, Inc., Eden Prairie, Minn., USA and Vygon-Laborpharmaceutic, Ecouen, France), positioned under sonographic guidance at ECMO onset [14]. In all patients the internal jugular vein or subclavian vein catheter leading to the right atrium was used for venous blood drainage.…”

“…Reconstruction of the right common carotid artery (rCCA) was performed in 7 patients. The internal jugular vein was reconstructed in 1 patient [7,14].…”

Predictors of Mortality in Pediatric Patients on Venoarterial Extracorporeal Membrane Oxygenation*

“…Thus, an AV-O2 was not obtained in these ten patients. Sites for ECMO cannula insertion included: neck (14), intrathoracic (6), and femoral (1). The percentage of intrathoracic cannulation was not higher than neck in Gr1 versus Gr2 (31% vs 29%, p = 1.00).…”