A multidisciplinary approach to VA ECMO cannulation in children

Area of Science:

• Pediatric critical care medicine
• Interventional cardiology
• Pediatric surgery

Background:

• Extracorporeal membrane oxygenation (ECMO) is vital for supporting gas exchange and circulation in critically ill patients.
• A multidisciplinary approach integrating pediatric surgery (PS) and interventional radiology (IR) can optimize ECMO cannulation procedures.

Purpose of the Study:

• To describe a collaborative, multidisciplinary strategy for peripheral veno-arterial (VA) ECMO cannulation in pediatric patients.
• To evaluate the feasibility and safety of this combined PS and IR approach.

Main Methods:

• A case series of pediatric patients (<18 years) undergoing percutaneous cannulation for peripheral VA ECMO by PS and IR.
• Exclusion criteria included cardiac patients and those cannulated by PS alone.
• Focus on the placement of arterial and venous catheters and antegrade distal perfusion cannulas (DPC).

Main Results:

• Five pediatric patients were included, with a median age of 16 years.
• Catheter sizes averaged 19 Fr (arterial) and 25 Fr (venous), placed in common femoral vessels.
• Two bleeding episodes occurred; no limb circulation loss was reported. Distal perfusion cannulas were successfully placed and removed.

Conclusions:

• The multidisciplinary PS and IR approach to peripheral VA ECMO cannulation is demonstrated as feasible and safe.
• Percutaneous placement and removal of distal perfusion cannulas (DPC) represent a key advantage, potentially maintaining limb perfusion.