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Intensivists Performed Percutaneous Bicaval Double-Lumen Echo-Guided Extracorporeal Membrane Oxygenation Cannulation at Bedside in Newborns and Children: A Retrospective Analysis

Moscatelli, Andrea MD1; Febbo, Francesca MD2; Buratti, Silvia MD1; Pezzato, Stefano MD1; Bagnasco, Francesca BS3; Lampugnani, Elisabetta MD1; Nuri, Halkawt MD4; Buffelli, Francesca MD5; Grasso, Chiara MD6; Castagnola, Elio MD7

Pediatric Critical Care Medicine: June 2019 - Volume 20 - Issue 6 - p 551-559
doi: 10.1097/PCC.0000000000001918
Extracorporeal Support

Objectives: To describe a single institution experience on echo-guided percutaneous bicaval double lumen extracorporeal membrane oxygenation cannulation performed at the bedside by intensivists.

Design: Retrospective observational study.

Setting: Extracorporeal membrane oxygenation team of a tertiary care children’s hospital.

Patients: All patients 0–14 years old undergoing venovenous extracorporeal membrane oxygenation from January 1, 2013, to January 1, 2018.

Interventions: None.

Measurements and Main Results: Thirty children underwent 32 extracorporeal membrane oxygenation runs. Median age at enrollment was 2 months (interquartile range, 0–20.5 mo), 65.6% of the runs (21 patients) were performed in newborns (n = 13, 40.6%) or infants (n = 8, 25%). Median preextracorporeal membrane oxygenation index was 66.9 (interquartile range, 50–85.6). Major comorbidities were present in 50% of patients. All patients were cannulated percutaneously. In two cases cannulation occurred from the left internal jugular vein. Extracorporeal membrane oxygenation was effective in increasing pH, arterial oxygen saturation, Pao2, and lowering Paco2. The overall differences in pre and postextracorporeal membrane oxygenation values were statistically significant, while stratifying patients according to the cannula diameter (mm)/major diameter of the cannulated internal jugular vein (mm) ratio (> 0.67 or ≤ 0.67), statistical significance was reached only for the highest ratio. Complications were observed in three runs: two cannula tip dislocations in the right atrium and one limited flow in the only case in which an Avalon cannula was not used. In 20 cases (62.5% of 32 runs), the cannulated vessel was patent at follow-up or autopsy. A ratio less than or equal to 0.67 or greater than 0.67 did not influence the occurrence rate of complications, nonpatency of the internal jugular vein, death for intracranial bleeding and death at 30 days from extracorporeal membrane oxygenation discontinuation. Overall cumulative survival at 30 days from extracorporeal membrane oxygenation discontinuation was 60% (95% CI, 40–75), with a survival advantage in the case of ratio greater than 0.67 (65%; 95% CI, 44–80 vs 25%; 95% CI, 0–60).

Conclusions: The described technique proved to be feasible, safe, and effective. Further investigation is needed.

1Neonatal and Pediatric Intensive Care Unit, Department of Surgery and Critical Care, IRCCS Istituto Giannina Gaslini, Genova, Italy.

2Postgraduate School in Anesthesia and Intensive Care, University of Genova, Genova, Italy.

3Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.

4Division of Cardiovascular Surgery, Department of Surgery and Critical Care, IRCCS Istituto Giannina Gaslini, Genova, Italy.

5Fetal-Perinatal Pathology Unit, Mother and Child Department, IRCCS Istituto Giannina Gaslini, PhD Course in Pediatric Sciences, Fetal-Perinatal and Pediatric Pathology, University of Genova, Genova, Italy.

6Postgraduate School in Anesthesia and Intensive Care, University of Catania, Catania, Italy.

7Division of Infectious Diseases, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy.

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The authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Andrea Moscatelli MD, Neonatal and Pediatric ICU, Department of Surgery and Critical Care, IRCCS Istituto Giannina Gaslini, Genova, Italy. E-mail:

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies