Safety of intensivist-led bedside decannulation of internal jugular bi-caval dual-lumen veno-venous extracorporeal membrane oxygenation cannulas and report of technique.
BACKGROUND
In the past decade, the rate and utilization of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has increased dramatically. A single catheter technique has recently come into favour for providing VV-ECMO. Although it has been shown that intensivists can safely place these catheters, the safety of decannulation by intensivists has not been reported in the literature.


OBJECTIVE
We describe a technique for safely decannulating the Avalon Elite VV-ECMO catheter at the bedside and assess the safety of this technique, as compared with the standard technique of decannulation in the operating room by a surgeon.


METHODS
This was a retrospective cohort design conducted at a tertiary care cardiovascular intensive care unit at an academic medical centre. All patients who underwent VV-ECMO from 2009 to 2014 were included in the study except for those who had been decannulated for withdrawal of care. Complication rates from decannulation were compared between patients who were decannulated by surgeons in the operating room and those decannulated by intensivists in the intensive care unit (ICU).


RESULTS
Twenty-eight patients were included in this study, of whom twenty-three patients (82%) were decannulated by intensivists, board certified in Critical Care Medicine through the American Board of Anesthesiology, while five (18%) the patients were decannulated by a surgeon. There was no significant difference in the complications rates between the surgeons (0) and intensivists (1) (P = 1.00). There were no major complications requiring operative intervention associated with decannulation identified in this study.


CONCLUSIONS
It is safe for intensivists to decannulate the Avalon Elite VV-ECMO cannula in the ICU using our purse-string suture technique. Performing these decannulations at the bedside compared to operating room may have positive clinical ramifications that include improved patient safety, timely patient care and reduced operating room costs.
Department of Anaesthesiology, Perioperative Medicine, Critical Care and Pain Medicine, University of Missouri Kansas City, USA. helleran@umkc.edu.
Aaron
A
Heller
John
J
Dollerschell
Joshua
J
Burk
Hailey
H
Haines
Jonathan
J
Kozinn
D000328:Adult; D002405:Catheterization, Central Venous / Q000379:methods*; D057785:Catheters; D015331:Cohort Studies; D003422:Critical Care; D020878:Device Removal / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010820:Physicians; D012189:Retrospective Studies; D066231:Surgeons; D013537:Sutures
ECMO; decannulation; extracorporeal membrane oxygenation; intensive care unit; safety