Percutaneous cannulation for pediatric venovenous extracorporeal life support

• Published in: Journal of pediatric surgery 2000-06, Vol.35 (6), p.943-947
• Main Authors: Foley, David S., Swaniker, Fresca, Pranikoff, Thomas, Bartlett, Robert H., Hirschl, Ronald B.
• Format: Article
• Language: English
• Subjects: Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; cannulation; Catheterization, Central Venous - methods; Catheterization, Peripheral - methods; Child; Child, Preschool; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Emergency and intensive respiratory care; Extracorporeal Circulation - methods; Extracorporeal life support; Femoral Vein; Humans; Intensive care medicine; Jugular Veins; Medical sciences; percutaneous; respiratory failure
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1053/jpsu.2000.6933

Background/Purpose: The objective of this study was to show the safety and efficacy of a method of percutaneous cannulation for venovenous extracorporeal life support (ECLS) access in nonneonatal (>10 kg) pediatric patients. Methods: Between June 1992 and October 1998, 26 pediatric patients (age range, 3 to 17 years; weight range, 19 to 100 kg) underwent attempted percutaneous cannulation for venovenous ECLS at our institution. Venous drainage access was attempted using a modified Seldinger technique via the right internal jugular vein (RIJ, n = 22) or right femoral vein (RFV, n = 4). Reinfusion access was attempted via the RFV (n = 19), RIJ (n = 4), or left femoral vein (n = 3). Results: The percutaneous technique was successful in 24 of 26 patients (92.3%). Maximum blood flow during ECLS was 80.1 ± 30.0 mL/kg/min, generating a postmembrane lung outlet pressure of 138 ± 54.8 mm Hg. Adequate gas exchange was achieved in all patients, and survival to discharge was 79.2%. There was no procedure-related mortality. Complications potentially related to the percutaneous technique included RIJ thrombosis (n = 1) detected after decannulation and cannula site bleeding (n = 3). Conclusion: Percutaneous access may be used safely and effectively for venovenous ECLS in pediatric patients. J Pediatr Surg 35:943-947. Copyright © 2000 by W.B. Saunders Company.