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Percutaneous Cannulation for Extracorporeal Membrane Oxygenation by Intensivists

A Retrospective Single-Institution Case Series*

Conrad, Steven A. MD, PhD, MCCM1; Grier, Laurie R. MD, FCCM1; Scott, L. Keith MD, FCCM2; Green, Rebecca MD1; Jordan, Mary RN, MSN3

doi: 10.1097/CCM.0000000000000883
Clinical Investigations

Objective: Extracorporeal membrane oxygenation provides support for patients with severe acute cardiopulmonary failure, allowing the application of lung or myocardial rest in anticipation of organ recovery, or as a bridge to long-term support. Advances in technology have improved the safety and ease of application of extracorporeal membrane oxygenation. Percutaneous cannulation is one of these advances and is now preferred over surgical cannulation in most cases. Percutaneous cannulation is increasingly performed by intensivists, cardiologists, interventional radiologists, and related specialties. The objective of this study is to review the experience of percutaneous cannulation by intensivists at a single institution.

Design: A retrospective review of 100 subjects undergoing percutaneous cannulation for extracorporeal membrane oxygenation.

Setting: Adult ICUs and PICUs at a tertiary academic medical institution.

Patients: Critically ill neonatal, pediatric, and adult subjects with severe respiratory and/or cardiac failure undergoing percutaneous cannulation for extracorporeal membrane oxygenation. Modes of support included venoarterial, venovenous, venovenoarterial, and arteriovenous.

Interventions Percutaneous extracorporeal membrane oxygenation.

Measurements and Main Results: Case reports submitted to the Extracorporeal Life Support Organization and hospital records of the subjects were retrospectively reviewed. Subject demographics, type of support, cannulation configuration, types of cannulas, use of imaging modalities, and complications were recorded and summarized. One hundred ninety cannulations with cannula sizes from size 12 to 31F were performed by four intensivists in 100 subjects. Twenty-three were arterial (12–16F) and 167 were venous (12–31F). Preinsertion ultrasound was performed in 93 subjects (93%), fluoroscopic guidance in 79 subjects (85% of nonarteriovenous subjects), and ultrasound-guided insertion was performed in 65 subjects (65%). Two major complications occurred, each associated with mortality. Cannulation was successful in all other subjects (98% of subjects and 99% of cannulations). There were no cases of cannula-related bloodstream infection.

Conclusions: Percutaneous cannulation for extracorporeal membrane oxygenation by intensivists can be performed with a high rate of success and a low rate of complications when accompanied by imaging support.

1Division of Critical Care Medicine, Louisiana State University Health Sciences Center, Shreveport, LA.

2Department of Anesthesiology, Section of Critical Care Medicine, Wake Forest University, Winston-Salem, NC.

3Department of Nursing, University Health, Shreveport, LA.

*See also p. 1146.

This work was performed at Extracorporeal Life Support Program, Louisiana State University Health Sciences Center, Shreveport, LA.

Supported, in part, by funding from the Department of Emergency Medicine, LSU Health Sciences Center, Shreveport, LA.

Presented, in part, at the 42nd Critical Care Congress, San Juan, PR, January 19–23, 2013.

Dr. Grier lectured for Hospira. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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