Related Experiment Video
Updated: Jan 9, 2026
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Peripheral veno-arterial ECMO cannulation in children: Review of the relevant ELSO publications
Jana Assy1, Matteo Di Nardo2, Issam El Rassi3
1Department of Pediatrics, University Hospital of Liege, Liège, Belgium.
Insights
Pediatric extracorporeal membrane oxygenation (ECMO) cannulation practices vary, with carotid access common despite risks. Femoral access shows limb complications, necessitating individualized strategies for pediatric VA-ECMO.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Extracorporeal life support
Background:
- Pediatric peripheral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) cannulation is complex due to patient variability.
- Current practices face challenges in optimizing safety and efficacy.
Purpose of the Study:
- To review current cannulation practices in pediatric VA-ECMO.
- To analyze neurologic and limb complications associated with carotid versus femoral artery access.
Main Methods:
- Literature review of current pediatric VA-ECMO cannulation practices.
- Analysis of large datasets from the Extracorporeal Life Support Organization (ELSO) registry.
- Focus on neurologic and limb complications comparing carotid and femoral artery access.
Main Results:
- Carotid cannulation remains prevalent in children over 5 years old (45%-94% usage).
- Neurologic complication rates ranged from 7% to 23%, with variable associations with carotid access.
- Femoral cannulation is linked to limb ischemia (7.5%-20%), potentially requiring vascular intervention or amputation.
Conclusions:
- Pediatric VA-ECMO cannulation lacks standardized practice, influenced by local expertise and anatomical factors.
- Growing evidence of limb complications with femoral access challenges current age-based transition points.
- Individualized decision-making based on patient characteristics and institutional experience is crucial for pediatric VA-ECMO cannulation.
Abstract:
BackgroundPeripheral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) cannulation in children poses a significant clinical challenge due to wide variations in body size, vessel caliber, and risk profiles.PurposeThis literature review examines current cannulation practices in pediatric patients.Research design Study sample & Data collectionThe study analyzed large datasets from the Extracorporeal Life Support Organization (ELSO) registry, focusing on neurologic and limb complications associated with carotid versus femoral artery use.ResultsDespite general recommendations favoring carotid cannulation in children under 15-20 kg and femoral access in larger, ambulatory patients, ELSO data show a persistent reliance on carotid cannulation even in older children. In four major ELSO studies, carotid use ranged from 45% to 94% among children over 5 years of age. Neurologic complication rates varied widely, from 7% to 23%, with some studies linking carotid access to higher risk of CNS injury, while others found no significant difference. Femoral cannulation, although theoretically safer neurologically, carried notable risks of limb ischemia-reported between 7.5% and 20%-and potential need for vascular interventions or amputations.ConclusionsThis review highlights the lack of standardized practice and the influence of local expertise, anatomical variability, and data limitations. It also underscores the need for clearer definitions and better reporting in future studies. While carotid cannulation remains prevalent across age groups, growing evidence of limb complications with femoral access invites reconsideration of the "transition point" in pediatric ECMO cannulation strategies. Until more definitive data emerge, individualized decision-making guided by patient characteristics and institutional experience remains essential.
