TY - JOUR
T1 - Emergency percutaneous, bicaval double-lumen, ECMO cannulation in neonates and infants
T2 - Insights from three consecutive cases
AU - Moscatelli, Andrea
AU - Buratti, Silvia
AU - Gregoretti, Cesare
AU - Lampugnani, Elisabetta
AU - Salvati, Pietro
AU - Marasini, Maurizio
AU - Ribera, Elena
AU - Fulcheri, Ezio
AU - Tuo, Pietro
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Background: Veno-venous extracorporeal membrane oxygenation (ECMO) is probably the preferable configuration to assist children with respiratory failure who do not respond to maximized conventional therapies. The single-vessel, double-lumen approach through the internal jugular vein is extremely advantageous, especially in infants, where femoral access presents limitations related to the small dimensions of the veins. In case of emergencies, ECMO might need to be started at the bedside, without the availability of fluoroscopic guidance. To our knowledge, a completely percutaneous approach has not been reported before in children younger than 1 year and weighing less than 5 kg. Methods: We describe 3 cases of emergency bedside, percutaneous, bicaval double-lumen cannulation under real-time transthoracic ultrasound control in 2 neonates and 1 infant. Results: In our experience, this approach proved to be safe, effective and time saving, while minimizing bleeding from the cannula insertion site. Cannulation times, from decision making to the beginning of ECMO flow, were 30, 28, 25 minutes respectively, from patient 1 to 3. We do not report any cannula-related injury to vessels and heart structures. Conclusions: Our preliminary data suggest that, with the described precautions, percutaneous, echo-guided, bicaval double-lumen cannulation in neonates and infants could be effective and free from major complications. Further evaluation should be warranted in the neonatal population.
AB - Background: Veno-venous extracorporeal membrane oxygenation (ECMO) is probably the preferable configuration to assist children with respiratory failure who do not respond to maximized conventional therapies. The single-vessel, double-lumen approach through the internal jugular vein is extremely advantageous, especially in infants, where femoral access presents limitations related to the small dimensions of the veins. In case of emergencies, ECMO might need to be started at the bedside, without the availability of fluoroscopic guidance. To our knowledge, a completely percutaneous approach has not been reported before in children younger than 1 year and weighing less than 5 kg. Methods: We describe 3 cases of emergency bedside, percutaneous, bicaval double-lumen cannulation under real-time transthoracic ultrasound control in 2 neonates and 1 infant. Results: In our experience, this approach proved to be safe, effective and time saving, while minimizing bleeding from the cannula insertion site. Cannulation times, from decision making to the beginning of ECMO flow, were 30, 28, 25 minutes respectively, from patient 1 to 3. We do not report any cannula-related injury to vessels and heart structures. Conclusions: Our preliminary data suggest that, with the described precautions, percutaneous, echo-guided, bicaval double-lumen cannulation in neonates and infants could be effective and free from major complications. Further evaluation should be warranted in the neonatal population.
KW - Bicaval double-lumen cannulation
KW - Echo-guided
KW - ECMO
KW - Infant
KW - Newborn
KW - Percutaneous
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U2 - 10.5301/ijao.5000432
DO - 10.5301/ijao.5000432
M3 - Article
C2 - 26428509
AN - SCOPUS:84944622236
VL - 38
SP - 517
EP - 521
JO - International Journal of Artificial Organs
JF - International Journal of Artificial Organs
SN - 0391-3988
IS - 9
ER -