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Pediatric arterial femoral cannulations for extracorporeal membrane oxygenation: Does size really matter?
Alejandro V Garcia1, Eric W Etchill1, Melania M Bembea2
1Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
Insights
Smaller femoral artery cannulas (15-16Fr) provide adequate flow for pediatric patients on extracorporeal membrane oxygenation (ECMO). Larger cannulas do not improve flow but may increase the risk of limb ischemia.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Extracorporeal Life Support
Background:
- Limited research exists on optimal femoral artery cannula sizing for pediatric extracorporeal membrane oxygenation (ECMO).
- Vascular complications associated with ECMO cannulation require further investigation.
Purpose of the Study:
- To compare the efficacy and safety of various femoral artery cannula sizes in pediatric patients undergoing ECMO.
- To determine if smaller cannulas can achieve adequate hemodynamic support while reducing complications.
Main Methods:
- Retrospective review of the Extracorporeal Life Support Organization (ELSO) database (2012-2017).
- Included patients aged 12-18 years, weighing >30 kg, on femoral venoarterial ECMO.
- Cannula sizes categorized as 15-16Fr, 17-18Fr, 19-20Fr, and ≥21Fr; complications and flow rates analyzed.
Main Results:
- No significant difference in mean arterial flow rates across cannula size groups.
- Increased risk of limb ischemia observed with ≥21Fr cannulas compared to 15-16Fr.
- Distal perfusion catheters increased mechanical complications but not significantly limb ischemia.
Conclusions:
- Femoral artery cannula size does not impact pump flow for hemodynamic support in pediatric ECMO.
- Larger cannula sizes (≥21Fr) are associated with a higher risk of ischemic complications.
- 15-16Fr cannulas appear safe and effective, potentially reducing vascular complications.
Background:
No studies exist comparing various femoral artery cannula sizes in children on ECMO. We hypothesize that smaller arterial cannulas provide adequate flow in children while decreasing vascular complications.
Methods:
We performed a retrospective review of the ELSO database from 2012-2017. We included children undergoing femoral venoarterial ECMO between ages 12 and 18 years and weighing more than 30 kg. Arterial cannula sizes were grouped as: 15-16Fr, 17-18Fr, 19-20Fr and ≥21Fr. Arterial pump flow, bleeding complications, limb ischemia, and mechanical complications were compared by cannula size. Distal perfusion catheter and percutaneous placement were also compared for complications.
Results:
A total of 429 patients were included with 28.2% 15-16Fr, 32.2% 17-18Fr, 22.8% 19-20Fr, and 16.8% ≥ 21Fr arterial femoral cannulas. Median age was lower in the 15-16Fr group compared to the largest cannula group (14.7 years vs 15.5 years, p < 0.01). The overall mean arterial flow was 57.4 +/- 17.0 mL/kg/min with no difference in mean arterial flow rates among the cannula size groups (p = 0.85). There were no significant differences in all complications, bleeding or mechanical complications by arterial cannula size group. However, there was an increased risk of limb ischemia in the ≥21Fr group compared to the 15-16Fr group (OR 4.38, 95% CI 1.24-15.43; p = 0.02). Distal perfusion catheter was shown to increase the risk of mechanical complications (OR 1.78; 95% CI 1.03-3.07; p = 0.04) but did not make a statistically significant difference in limb ischemia (OR 0.37; 95% CI 0.12-1.11; p = 0.07).
Conclusion:
Review of the ELSO database demonstrates that the use of larger arterial cannulas compared to 15-16Fr cannulas are not needed to achieve similar pump flows for hemodynamic support but the largest cannula sizes may increase the risk of ischemic complications.
