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

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

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background/Purpose: Cervical extracorporeal membrane oxygenation (ECMO) cannula position is often difficult to confirm by chest x-ray alone. Malposition requires a second surgery to rectify the problem. Reoperation places the patient at risk for infection, bleeding, or death. This study analyzes indications for cannula repositioning and suggests an alternative standard for intraoperative evaluation of catheter function as it relates to position. Methods: The authors reviewed charts of 73 patients placed on arterio-venous ECMO through cervical vascular access. Reasons for repositioning of either cannula at the initial surgery or postoperatively were recorded. Results: Of 73 patients, 18 (24.6%) required either arterial cannula or venous cannula repositioning. In 10 (55%) of these patients, cannula malposition was not detected by chest x-ray during the initial cannulation, and they therefore required a second cervical exploration for repositioning. Conclusions: Chest x-ray is not sensitive in demonstrating malpositioned cervical ECMO cannulae. Two-dimensional ECHO before wound closure, may be a superior, more cost effective means of assessing cannula placement and function than x-ray alone. Confirmation of cannula position and function, before wound closure, would reduce the risks involved with cervical reexploretion.

Original languageEnglish (US)
Pages (from-to)929-931
Number of pages3
JournalJournal of Pediatric Surgery
Volume33
Issue number6
DOIs
StatePublished - Jun 1998
Externally publishedYes

Fingerprint

Extracorporeal Membrane Oxygenation
X-Rays
Thorax
Cannula
Wounds and Injuries
Reoperation
Catheterization
Blood Vessels
Catheters
Hemorrhage
Costs and Cost Analysis

Keywords

  • Echocardiography
  • Extracorporeal life support organization
  • Extracorporeal membrane oxygenation

ASJC Scopus subject areas

  • Surgery

Cite this

Irish, M. S., O'Toole, S. J., Kapur, P., Bambini, D. A., Azizkhan, R. G., Allen, J. E., ... Glick, P. L. (1998). Cervical ECMO cannula placement in infants and children: Recommendations for assessment of adequate positioning and function. Journal of Pediatric Surgery, 33(6), 929-931. https://doi.org/10.1016/S0022-3468(98)90676-5

Cervical ECMO cannula placement in infants and children : Recommendations for assessment of adequate positioning and function. / Irish, Michael S.; O'Toole, Stuart J.; Kapur, Pierina; Bambini, Daniel A.; Azizkhan, Richard G.; Allen, James E.; Caty, Michael G.; Gilbert, James C.; Steinhorn, Robin H; Glick, Philip L.

In: Journal of Pediatric Surgery, Vol. 33, No. 6, 06.1998, p. 929-931.

Research output: Contribution to journalArticle

Irish, MS, O'Toole, SJ, Kapur, P, Bambini, DA, Azizkhan, RG, Allen, JE, Caty, MG, Gilbert, JC, Steinhorn, RH & Glick, PL 1998, 'Cervical ECMO cannula placement in infants and children: Recommendations for assessment of adequate positioning and function', Journal of Pediatric Surgery, vol. 33, no. 6, pp. 929-931. https://doi.org/10.1016/S0022-3468(98)90676-5
Irish, Michael S. ; O'Toole, Stuart J. ; Kapur, Pierina ; Bambini, Daniel A. ; Azizkhan, Richard G. ; Allen, James E. ; Caty, Michael G. ; Gilbert, James C. ; Steinhorn, Robin H ; Glick, Philip L. / Cervical ECMO cannula placement in infants and children : Recommendations for assessment of adequate positioning and function. In: Journal of Pediatric Surgery. 1998 ; Vol. 33, No. 6. pp. 929-931.
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abstract = "Background/Purpose: Cervical extracorporeal membrane oxygenation (ECMO) cannula position is often difficult to confirm by chest x-ray alone. Malposition requires a second surgery to rectify the problem. Reoperation places the patient at risk for infection, bleeding, or death. This study analyzes indications for cannula repositioning and suggests an alternative standard for intraoperative evaluation of catheter function as it relates to position. Methods: The authors reviewed charts of 73 patients placed on arterio-venous ECMO through cervical vascular access. Reasons for repositioning of either cannula at the initial surgery or postoperatively were recorded. Results: Of 73 patients, 18 (24.6{\%}) required either arterial cannula or venous cannula repositioning. In 10 (55{\%}) of these patients, cannula malposition was not detected by chest x-ray during the initial cannulation, and they therefore required a second cervical exploration for repositioning. Conclusions: Chest x-ray is not sensitive in demonstrating malpositioned cervical ECMO cannulae. Two-dimensional ECHO before wound closure, may be a superior, more cost effective means of assessing cannula placement and function than x-ray alone. Confirmation of cannula position and function, before wound closure, would reduce the risks involved with cervical reexploretion.",
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