Percutaneous Echo-Guided Cervical Venoarterial Extracorporeal Membrane Oxygenation Cannulation by Intensivists in Neonates and Children

Cervical cannulation is the standard approach for venoarterial extracorporeal membrane oxygenation (VA-ECMO) in neonates and small children but is traditionally performed surgically. We report our initial experience with bedside percutaneous ultrasound- and echocardiography-guided cervical VA-ECMO cannulation performed by intensivists. Three pediatric patients underwent percutaneous right common carotid artery and internal jugular vein cannulation. Vascular access, guidewire advancement, tract dilation, and cannula positioning were guided by ultrasound and transthoracic echocardiography. Median age was 5 months (range, 20 days-6 years) and median weight 7 kg (range, 3-15 kg). Extracorporeal membrane oxygenation was initiated for extracorporeal cardiopulmonary resuscitation in two patients and refractory cardiogenic shock in one. Cannulation was successful in all patients without surgical conversion, with a median skin-puncture-to-flow time of 32 minutes (range, 28-35). Target flow (>100 ml/kg/min) was achieved in two patients. No major cannulation-related vascular or cardiac complications occurred. Two patients died on ECMO, while one survived without signs of stroke on follow-up magnetic resonance imaging. Vascular integrity was documented by postmortem examination or Doppler follow-up. Bedside percutaneous echo-guided cervical VA-ECMO cannulation by experienced intensivists appears technically feasible in pediatric patients. Further studies are needed to establish safety, reproducibility, effectiveness, and potential advantages over conventional surgical cannulation.