113: Single Center Experience with Percutaneous Cannulation in Neonatal Veno-Venous ECMO

Résumé fourni par la source

Background: The landscape of ECMO for respiratory failure has changed over the past years, primarily because of unavailable equipment. OriGen catheters were recalled in 2019 compelling centers to opt for veno-arterial (VA) ECMO given technical complexity and reported complications of Avalon bicaval catheter placement. We describe our experience with percutaneous veno-venous (VV) ECMO cannulation and short-term neonatal outcomes in our institution. Methods: Retrospective cohort review of VV ECMO patients from 2019 to 2023 in a level IV referral NICU. Multiple process changes were sequentially implemented in 2019 to ensure training and safety of percutaneous cannulation, and cannula position during the ECMO run (Figure 1). Patient and ECMO characteristics as well as complications, imaging studies and short-term outcomes were collected. Results: Ten neonatal patients were cannulated onto VV ECMO, 7 via percutaneous approach and 3 open (Table 1). Of the open cannulations, 1 was surgeon preference, 1 patient instability and 1 catheter malposition requiring conversion to VA ECMO. All open cannulations involved vessel ligation at decannulation. Complications of percutaneous cannulation included catheter malposition (n=4) and post decannulation vessel thrombosis (n=4) requiring systemic anticoagulation (n=3). There were no life-threatening complications such as vessel or cardiac perforation. Imaging studies for cannula placement and position monitoring varied (Table 2). Conclusions: A multidisciplinary practice change involving education, simulation training, and standardized protocol changes led to the successful percutaneous neonatal VV ECMO cannulation in a referral ECMO center without life-threatening complications. Next steps include process improvements to safely decrease imaging burden for cannula position monitoring.

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