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Comparing Percutaneous to Open Access for Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure

Cairo, Sarah B., MD, MPH1; Arbuthnot, Mary, DO2; Boomer, Laura, MD3; Dingeldein, Michael W., MD4; Feliz, Alexander, MD5; Gadepalli, Samir, MD6; Newton, Christopher R., MD7; Puligandla, Pramod, MD8; Ricca, Robert Jr, MD9; Rycus, Peter10; Vogel, Adam M., MD11; Yu, Guan, PhD12; Chen, Ziqiang, PhD12; Rothstein, David H., MD MS1,13 on behalf of the American Pediatric Surgical Association Critical Care Committee

Pediatric Critical Care Medicine: October 2018 - Volume 19 - Issue 10 - p 981–991
doi: 10.1097/PCC.0000000000001691
Extracorporeal Support

Objectives: Evaluate trends in method of access (percutaneous cannulation vs open cannulation) for pediatric extracorporeal membrane oxygenation and determine the effects of cannulation method on morbidity and mortality.

Design: Retrospective cohort study.

Setting and Subjects: The Extracorporeal Life Support Organization’s registry was queried for pediatric patients on extracorporeal membrane oxygenation for respiratory failure from 2007 to 2015.

Inverventions: None.

Measurements and Main Results: Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to 70% (p < 0.001). Percutaneous cannulation patients were more commonly male (24.2% vs 21.5%; p = 0.01), older (average 7.6 vs 4.5 yr; p < 0.001), and heavier (average 33.0 vs 20.2 kg; p < 0.001). Subset analysis of patients on venovenous extracorporeal membrane oxygenation revealed higher rates of mechanical complications due to blood clots (28.9% vs 22.6%; p = 0.003) or cannula problems (18.9% vs 12.7%; p < 0.001), cannula site bleeding (25.3% vs 20.2%; p = 0.01) and increased rates of cannula site repair in the open cannulation cohort. Limb related complications were not significantly different on subset analysis for venovenous extracorporeal membrane oxygenation patients stratified by access site. Logistic regression analysis revealed that method of access was not associated with a difference in mortality.

Conclusions: The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique.

1Department of Pediatric Surgery, John R Oishei Children’s Hospital, Buffalo, NY.

2Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA.

3Department of Surgery, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA.

4Department of Pediatric Surgery, Rainbow Babies and Children Hospital, Cleveland, OH.

5Department of Pediatric Surgery, University of Tennessee Health Sciences, Memphis, TN.

6Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI.

7Department of Pediatric Surgery, University of California at San Francisco Benioff Children’s Hospital Oakland, San Francisco, CA.

8Department of Pediatric Surgery, Montreal Children’s Hospital, Montréal, QC, Canada.

9Department of Pediatric and General Surgery, Naval Medical Center Portsmouth, Portsmouth, VA.

10Extracorporeal Life Support Organization, Ann Arbor, MI.

11Department of Pediatric General Surgery, Texas Children’s Hospital, Houston, TX.

12Department of Biostatistics, State University of New York, University at Buffalo, Buffalo, NY.

13Department of Surgery, State University of New York, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.

A list of the American Pediatric Surgical Association Critical Care Committee are listed in the Acknowledgments.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Statistical support was made possible through the grant award: National Institutes of Health 1UL1TR001412-01 Buffalo Clinical and Translational Research Center.

Dr. Arbuthnot disclosed government work (surgical resident at a military residency program). Dr. Ricca disclosed government work (military service member). Dr. Yu’s institution received funding from Clinical and Translational Science Institute, and he received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: Scairo2@gmail.com

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies