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Updated: Sep 28, 2025
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Utility of cephalic drains in infants receiving extracorporeal membrane oxygenation
Allison T Rose1,2, Joel Davis2, Helen O Williams1,2
1Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Insights
Cephalic drains (CDs) in extracorporeal membrane oxygenation (ECMO) are often patent and provide significant venous drainage. However, clotted CDs are linked to longer ECMO runs and lower survival rates.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Biomedical engineering
Background:
- The use of cephalic drains (CDs) to enhance venous drainage during extracorporeal membrane oxygenation (ECMO) varies.
- Understanding the efficacy and complications associated with CDs is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the institutional experience with cephalic drains in pediatric ECMO.
- To analyze flow rates, patency, and complication rates associated with CD use.
- To compare outcomes between patients with and without cephalic drains.
Main Methods:
- Retrospective cohort study of infants (<12 months) undergoing ECMO.
- Data collected on CD flow rates, patency, and time to clot.
- Demographic and complication data analyzed for all patients.
Main Results:
- 83% of patients had a CD, with 93.2% remaining patent.
- CDs contributed over 30% of ECMO flow.
- Clotted CDs correlated with longer ECMO duration and reduced survival (14% vs 70%).
- Mechanical complications were higher with CDs, while seizures were more common without them.
Conclusions:
- The majority of cephalic drains in this cohort remained patent and provided significant venous drainage.
- While mechanical issues occurred with CDs, they did not appear to cause adverse clinical sequelae.
- Further research is needed to fully understand the short- and long-term impact of CDs on ECMO outcomes.
Introduction:
The addition of cephalic drains (CDs) in extracorporeal membrane oxygenation (ECMO) to augment venous drainage may offer benefit, though their use is varied. Our objective was to describe our institution's experience with CDs including flow rates and patency. We also compared complication rates between patients with and without a CD.
Methods:
This retrospective cohort study included infants <12 months of age cannulated for ECMO between January 1, 2010 and September 30, 2019 at a single institution. Flow data were obtained for those with a CD. Demographic and complication rates were obtained for all.
Results:
Of 264 patients in the final cohort, 220 (83%) had a CD of which 93.2% remained patent to decannulation. CDs typically provided 30% or more of ECMO flow throughout the ECMO run. The median time to CD clot was 139 h (range 48-635 h). Patients with a clotted CD had longer ECMO runs than those whose CD remained patent (median 382 h [IQR 217-538] vs 139 h [IQR 91-246], p < 0.001). Survival to discharge was lower for those with clotted versus patent CD (14% vs 70%, p < 0.001). Mechanical complications were more common in patients with CD (p = 0.005). Seizures were more common in those without a CD (p = 0.021).
Conclusions:
In this cohort, the majority of CDs placed remained patent at decannulation and provided substantial additional venous drainage. Mechanical problems were common in patients with CDs, but without clinical sequelae. Further study is warranted to elucidate CD impact on short- and long-term outcomes.
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