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Best Practices for Vessel Management in Pediatric Extracorporeal Membrane Oxygenation Cannulation, Decannulation, and
Katherine M McDermott1, Mohammed Moursi2, Sandra Tomita3
1Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) in children can lead to vascular complications. This review details pediatric ECMO, its vascular risks, and best practices for cannulation and management to improve patient outcomes.
Area of Science:
- Pediatric critical care medicine
- Vascular surgery
- Cardiopulmonary support
Background:
- Extracorporeal membrane oxygenation (ECMO) use has grown in complex pediatric populations with cardiopulmonary failure.
- Vascular complications, such as iatrogenic injury, are common despite preserved survival rates in pediatric ECMO patients.
Purpose of the Study:
- To provide a comprehensive review of pediatric ECMO and associated vascular complications.
- To guide interventionalists on best practices for cannula site selection, technique, and complication management.
Main Methods:
- Overview of pediatric ECMO epidemiology and vascular complication incidence.
- Description of peripheral cannulation equipment, techniques, and trends.
- Review of current evidence on best practices and management strategies.
Main Results:
- Common peripheral cannulation techniques and their associated vascular complication rates are described.
- Evidence-based best practices for cannulation, decannulation, and complication management are reviewed.
- Areas of practice variation and future research needs are highlighted.
Conclusions:
- Optimizing cannulation strategies and managing vascular complications are crucial in pediatric ECMO.
- Further research is needed in areas like vessel-sparing techniques and the role of subspecialty proceduralists.
Abstract:
Extracorporeal membrane oxygenation (ECMO) to support neonates and children with cardiopulmonary failure was first described in the 1970s, since which time its use has expanded to an increasingly complex and heterogenous pediatric population. Despite preserved survival outcomes, complications of ECMO use, including iatrogenic vascular injury, are common. Here, we provide a brief overview of the epidemiology of pediatric ECMO and associated vascular complications; describe common peripheral cannulation equipment and techniques, trends in cannulation and decannulation strategies, and respective incidence of vascular complications; and review existing evidence for best practices in cannula site selection, cannulation technique, decannulation strategies, and management of vascular complications, with the goal of providing a comprehensive review for interventionalists involved in the care of pediatric ECMO patients. Areas of wide practice variation in vessel management-application of vessel-sparing cervical venoarterial cannulation, the use of distal perfusion catheters in femoral arterial cannulation, and best practices for percutaneous single-lumen venovenous cannulation, as examples-areas of focus for future research, and the potential role of vascular surgeons and other subspecialty proceduralists in the care of pediatric ECMO patients are highlighted. LEVEL OF EVIDENCE: V.
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