title: Cervical ECMO cannula placement in infants and children: recommendations for assessment of adequate positioning and function.
abstract: OBJECTIVE
  Cervical extracorporeal membrane oxygenation (ECMO) cannula position is often difficult to confirm by chest x-ray alone. Malposition requires a second surgery to rectify the problem. Reoperation places the patient at risk for infection, bleeding, or death. This study analyzes indications for cannula repositioning and suggests an alternative standard for intraoperative evaluation of catheter function as it relates to position.
  
  
  METHODS
  The authors reviewed charts of 73 patients placed on arterio-venous ECMO through cervical vascular access. Reasons for repositioning of either cannula at the initial surgery or postoperatively were recorded.
  
  
  RESULTS
  Of 73 patients, 18 (24.6%) required either arterial cannula or venous cannula repositioning. In 10 (55%) of these patients, cannula malposition was not detected by chest x-ray during the initial cannulation, and they therefore required a second cervical exploration for repositioning.
  
  
  CONCLUSIONS
  Chest x-ray is not sensitive in demonstrating malpositioned cervical ECMO cannulae. Two-dimensional ECHO before wound closure, may be a superior, more cost effective means of assessing cannula placement and function than x-ray alone. Confirmation of cannula position and function, before wound closure, would reduce the risks involved with cervical reexploration.
authors.affiliation: Department of Pediatric Surgery, The Children's Hospital of Buffalo, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, 14222, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Irish
authors.forename: S J
authors.initials: SJ
authors.lastname: O'Toole
authors.forename: P
authors.initials: P
authors.lastname: Kapur
authors.forename: D A
authors.initials: DA
authors.lastname: Bambini
authors.forename: R G
authors.initials: RG
authors.lastname: Azizkhan
authors.forename: J E
authors.initials: JE
authors.lastname: Allen
authors.forename: M G
authors.initials: MG
authors.lastname: Caty
authors.forename: J C
authors.initials: JC
authors.lastname: Gilbert
authors.forename: R H
authors.initials: RH
authors.lastname: Steinhorn
authors.forename: P L
authors.initials: PL
authors.lastname: Glick
mesh_terms: D002404:Catheterization / Q000379:methods*; D002648:Child; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007223:Infant