Avalon catheters in pediatric patients requiring ECMO: Placement and migration problems

Area of Science:

• Pediatric critical care medicine
• Cardiopulmonary support technologies

Background:

• The Avalon dual-lumen venovenous catheter offers advantages but lacks established pediatric placement protocols.
• Effective management and placement techniques in children remain underexplored.

Purpose of the Study:

• To assess institutional outcomes and complications associated with Avalon catheter use in pediatric patients.
• To evaluate the efficacy of different imaging modalities in guiding placement and reducing malposition.

Main Methods:

• Retrospective review of pediatric patients (excluding congenital heart disease) receiving Avalon catheters for respiratory failure from 2009-2016.
• Standard extracorporeal membrane oxygenation (ECMO) protocol with daily chest X-ray and intermittent echocardiography (ECHO) for cannula monitoring.
• Data collection included demographics, diagnosis, predicted mortality, ECMO duration, complications, and survival; primary outcome was catheter repositioning.

Main Results:

• Twenty-five pediatric patients were analyzed, with a mean age of 8.3 years and 15 days of ECMO support. Overall survival was 68%.
• Cannula malposition occurred in 52% of patients, necessitating repositioning in 69% of those cases.
• Fluoroscopy-guided placement (n=14) resulted in significantly lower repositioning rates (21%) compared to non-fluoroscopy-guided placement (64%, p=0.05).

Conclusions:

• The Avalon catheter is associated with a high rate of complications in pediatric patients.
• Ultrasound guidance is crucial for safe percutaneous access.
• Integrating intraoperative fluoroscopy with echocardiography demonstrably reduces catheter malposition events.