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Pediatric Femoral Arterial Cannulations in Extracorporeal Membrane Oxygenation

A Review and Strategies for Optimization

Fraser, Charles D. III; Kovler, Mark L.; Guzman, William Jr; Rhee, Daniel S.; Lum, Ying Wei; Alaish, Samuel M.; Garcia, Alejandro V.

doi: 10.1097/MAT.0000000000000884
Review Article

Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is a treatment strategy for pediatric patients with cardiopulmonary failure. Femoral cannulation is a commonly used technique for obtaining central access in children and adolescents despite high rates of vascular complications. Ischemic limb complications remain one of the most common problems facing survivors of femoral VA ECMO. Our aim is to review the literature on femoral cannulation in children and to present a review of techniques for femoral cannula placement, decannulation, and arterial repair to help minimize and ameliorate complications related to cannulation. We performed a literature review for pediatric ECMO cannulation, complications, and femoral artery repair in pediatric patients. We focused on the management of arterial and ischemia-related complications during and after ECMO support via femoral cannulation. Vascular complications are not infrequent for patients requiring ECMO support via femoral cannulation. As such, judicious distal perfusion monitoring as well as augmentation of distal flow are important strategies during mechanical support. The use of distal perfusion catheters can be used to minimize the risk of limb ischemia. As femoral cannulation grows more popular in pediatric patients, strategies for arterial repair are essential to ensure extremity perfusion upon decannulation.

From the Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.

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Submitted for consideration March 2018; accepted for publication in revised form August 2018.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Charles D. Fraser III, Department of Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Bloomberg Building 7325, Baltimore, MD 21287.

Copyright © 2019 by the American Society for Artificial Internal Organs