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ECMO cannulation techniques in children: Heterogeneous and often complicated
Lucas Moratilla-Lapeña1, María Del Carmen Sarmiento1, Alejandro Madurga1
1Pediatric Surgery Department, Hospital Universitario La Paz, Madrid, Spain.
Journal of Pediatric Surgery
|June 25, 2026
Summary
Cervical ECMO cannulation in children has high complication rates and inconsistent management. Using a 6 Fr arterial cannula was fatal, indicating an 8 Fr cannula is preferable, or central ECMO should be considered.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Extracorporeal membrane oxygenation (ECMO) techniques
Background:
- Growing indications for ECMO necessitate standardized cannulation guidelines.
- Current ECMO practices lack standardized cervical cannulation protocols.
- This study addresses complications and management variability in pediatric cervical ECMO.
Purpose of the Study:
- To describe complications associated with cervical ECMO in children.
- To analyze variability in cervical ECMO management and outcomes.
- To identify factors influencing complication rates and patient survival.
Main Methods:
- Retrospective review of 27 pediatric patients undergoing cervical ECMO (2016-2023).
- Data collected on demographics, ECMO technique, cannula size, surgeon specialty, fixation method, complications, and outcomes.
- Complications classified using ELSO criteria; surgeon specialty (pediatric vs. cardiothoracic) and fixation (ligation vs. non-ligation) analyzed.
Main Results:
- High complication rate (74%), predominantly mechanical (52%).
- Pediatric surgeons using ligation fixation had more cannula malposition and bleeding compared to cardiothoracic surgeons using non-ligation.
- All patients with 6 Fr arterial cannulas died; 8 Fr cannulas are recommended. Arterial repair patency was higher with non-ligation fixation (100%) vs. ligation (80%).
Conclusions:
- Cervical ECMO cannulation is associated with significant complications and management heterogeneity.
- The 6 Fr arterial cannula size is linked to mortality, advocating for 8 Fr cannulas or central ECMO.
- Standardization of techniques and cannula selection is crucial for improving outcomes in pediatric cervical ECMO.
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