Percutaneous cannulation for extracorporeal membrane oxygenation by intensivists: a retrospective single-institution case series.
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.


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


METHODS
Adult ICUs and PICUs at a tertiary academic medical institution.


METHODS
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.


METHODS
Percutaneous extracorporeal membrane oxygenation.


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.
Steven A
SA
Conrad
Laurie R
LR
Grier
L Keith
LK
Scott
Rebecca
R
Green
Mary
M
Jordan
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008511:Medicine; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult