221: The Crescent™ Right Atrial Dual-Lumen VV-ECMO Cannula: A Review of Early Outcomes in the Neonatal and Pediatric Populations

Résumé fourni par la source

The use of veno-venous (VV) extracorporeal membrane oxygenation (ECMO) in neonatal and pediatric patients declined in 2018 due to lack of an available dual-lumen (DL) right-atrial (RA) cannula. The Crescent™ RA cannula was subsequently developed in 2021: the only DL VV cannula designed to have its tip in the right atrium. This study aims to assess patient outcomes and cannula-related complications during the initial two years of cannula use in patients less than 18 years of age. We performed a multicenter retrospective cohort study of 165 patients (58 neonatal, 107 pediatric) placed on VV-ECMO using the Crescent™ RA cannula from September 2021 through August 2023 across 20 U.S. institutions. We collected data on patient characteristics, cannulation procedures, ECMO runs, complications, and survival. We analyzed data with descriptive statistics. Echocardiogram, fluoroscopy, or both modalities were used in 64.9%, 20.6%, and 6.7% of cannulations, respectively. The cannula was surgically repositioned in 17.6% of patients. Conversion to an alternate ECMO modality occurred in 9.7% of patients, and clinically significant recirculation was observed in 10.3%. Cannula-related injuries to the heart or great vessels occurred in 5.5% of patients: directly leading to death in 1.8% and possibly contributing to death in 1.8%. Survival rates to decannulation and hospital discharge were 78.2% and 70.3%, respectively. Our data support the effectiveness of the Crescent™ RA cannula for VV-ECMO support. A minor risk of damage to major cardiovascular structures exists. To mitigate this risk, thorough education on proper cannula placement, regular imaging, and constant vigilance are essential.

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