Echocardiographic Guidance During Neonatal and Pediatric Jugular Cannulation for ECMO.
J Surg Res
; 232: 517-523, 2018 12.
Article
em En
| MEDLINE
| ID: mdl-30463767
ABSTRACT
BACKGROUND:
Internal jugular vein extracorporeal membrane oxygenation (ECMO) cannula position is traditionally confirmed via plain film. Misplaced cannulae can result in need for repositioning and increased morbidity. Echocardiography (ECHO) may be used during cannulation as a more accurate means of guiding cannula position. This study reviews the effect of a protocol encouraging the use of ECHO at cannulation. METHODS AND MATERIALS Single institution retrospective review of patients who received ECMO support using jugular venous cannulation. We compared those who underwent ECHO (ECHO+) at the time of cannulation with those who did not (ECHO-).RESULTS:
Eighty-nine patients were included 26 ECHO+, 63 ECHO-. Most ECHO+ patients underwent dual-lumen veno-venous (VV) cannulation (65%); 32% of ECHO- patients had VV support (P = 0.003). There was no difference in the rate of cannula repositioning between the two groups 8% ECHO+ and 10% ECHO-, P = 0.78. In the VV ECMO subgroup, ECHO+ patients required no repositioning (0/17), while 20% (4/20) of ECHO- VV patients did (P = 0.10). After cannulation, there were 0.58 ECHO studies per patient to verify cannula position in the ECHO+ group compared with 0.22 in the ECHO- group (P = 0.02). Each group had a major mechanical complication atrial perforation from a guidewire during cannulation in ECHO+ and late atrial perforation from a loose cannula in ECHO-, and there was no difference in minor complications.CONCLUSIONS:
ECHO guidance during neonatal and pediatric jugular cannulation for ECMO did not decrease morbidity or reduce the need for cannula repositioning. ECHO may still be a useful adjunct for precise placement of a dual-lumen VV cannula and during difficult cannulations.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cateterismo Venoso Central
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Ecocardiografia
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Oxigenação por Membrana Extracorpórea
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Veias Jugulares
Tipo de estudo:
Guideline
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Observational_studies
Limite:
Adolescent
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Child
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Child, preschool
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Humans
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Infant
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Newborn
Idioma:
En
Revista:
J Surg Res
Ano de publicação:
2018
Tipo de documento:
Article