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Kipfmueller F, Bo B, Schmitt J, Sabir H, Schroeder L, Mueller A, Dresbach T. Percutaneous, ultrasound-guided single- and multisite cannulation for veno-venous extracorporeal membrane oxygenation in neonates. Pediatr Pulmonol 2023; 58:2574-2582. [PMID: 37314186 DOI: 10.1002/ppul.26555] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/08/2023] [Accepted: 06/03/2023] [Indexed: 06/15/2023]
Abstract
AIMS Extracorporeal membrane oxygenation (ECMO) is a widely used technique to support neonates with severe respiratory failure. Data on percutaneous, ultrasound-guided veno-venous (VV) ECMO cannulation in neonates is still scarce. Aim of this study was to describe our institutional experience with ultrasound-guided percutaneous, VV ECMO cannulation in neonates with severe respiratory failure. METHODS Neonates receiving ECMO support at our department between January 2017 and January 2021 were retrospectively identified. Patients receiving VV ECMO cannulation performed by the percutaneous Seldinger technique by single- or multisite cannulation were analyzed. RESULTS A total of 54 neonates received ECMO cannulation performed by the percutaneous Seldinger technique. In 39 patients (72%) a 13 French bicaval dual-lumen cannula was inserted and in 15 patients (28%) two single-lumen cannulae were used. Cannulae positioning using the multisite approach was in all cases as desired. The tip of the 13 French cannula was located in the IVC in 35/39 patients, in four patients position was too proximal but did not dislocate during the ECMO run. One (2%) preterm neonate (weight 1.75 kg) developed a cardiac tamponade which was successfully managed with drainage. Median duration of ECMO was 7 days (interquartile range: 5-16 days). Forty-four patients (82%) were successfully weaned from ECMO and in 31/44 (71%) the ECMO cannulae were removed with a delay of 0.9-7.2 days (median 2.8 days) after weaning without noticing complications. CONCLUSIONS A correct cannula placement using the ultrasound-guided percutaneous Seldinger technique, for both single- and multisite cannulation, seems feasible in most neonatal patients receiving VV ECMO.
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Affiliation(s)
- Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
- Division of Congenital Malformations, Center for Rare Diseases Bonn, University Hospital Bonn, Bonn, Germany
| | - Bartolomeo Bo
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Joachim Schmitt
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Hemmen Sabir
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Lukas Schroeder
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
- Division of Congenital Malformations, Center for Rare Diseases Bonn, University Hospital Bonn, Bonn, Germany
| | - Till Dresbach
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
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Mayer A, Macchini F, Raffaeli G, Ghirardello S, Schena F, Amodeo I, Mauri L, Baracetti C, Parente V, Carro C, Mosca F, Cavallaro G. When the unexpected happens: intracardiac extracorporeal membrane oxygenation venous cannula kinking. Perfusion 2020; 36:769-771. [PMID: 32933371 DOI: 10.1177/0267659120957838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alessandra Mayer
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Genny Raffaeli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ghirardello
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Schena
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Amodeo
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucia Mauri
- Cardiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Baracetti
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Parente
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Betamed Perfusion Service, Rome, Italy
| | - Cristina Carro
- Division of Pediatric Cardiac Surgery, GOM-Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Cavallaro
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Successful Right Atrium-Pulmonary Artery ECMO in an Infant With Severe Necrotizing Pneumonia and Bilateral Bronchopleural Fistula. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1768-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Intensivists Performed Percutaneous Bicaval Double-Lumen Echo-Guided Extracorporeal Membrane Oxygenation Cannulation at Bedside in Newborns and Children: A Retrospective Analysis. Pediatr Crit Care Med 2019; 20:551-559. [PMID: 30925572 DOI: 10.1097/pcc.0000000000001918] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe a single institution experience on echo-guided percutaneous bicaval double lumen extracorporeal membrane oxygenation cannulation performed at the bedside by intensivists. DESIGN Retrospective observational study. SETTING Extracorporeal membrane oxygenation team of a tertiary care children's hospital. PATIENTS All patients 0-14 years old undergoing venovenous extracorporeal membrane oxygenation from January 1, 2013, to January 1, 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Thirty children underwent 32 extracorporeal membrane oxygenation runs. Median age at enrollment was 2 months (interquartile range, 0-20.5 mo), 65.6% of the runs (21 patients) were performed in newborns (n = 13, 40.6%) or infants (n = 8, 25%). Median preextracorporeal membrane oxygenation index was 66.9 (interquartile range, 50-85.6). Major comorbidities were present in 50% of patients. All patients were cannulated percutaneously. In two cases cannulation occurred from the left internal jugular vein. Extracorporeal membrane oxygenation was effective in increasing pH, arterial oxygen saturation, PaO2, and lowering PaCO2. The overall differences in pre and postextracorporeal membrane oxygenation values were statistically significant, while stratifying patients according to the cannula diameter (mm)/major diameter of the cannulated internal jugular vein (mm) ratio (> 0.67 or ≤ 0.67), statistical significance was reached only for the highest ratio. Complications were observed in three runs: two cannula tip dislocations in the right atrium and one limited flow in the only case in which an Avalon cannula was not used. In 20 cases (62.5% of 32 runs), the cannulated vessel was patent at follow-up or autopsy. A ratio less than or equal to 0.67 or greater than 0.67 did not influence the occurrence rate of complications, nonpatency of the internal jugular vein, death for intracranial bleeding and death at 30 days from extracorporeal membrane oxygenation discontinuation. Overall cumulative survival at 30 days from extracorporeal membrane oxygenation discontinuation was 60% (95% CI, 40-75), with a survival advantage in the case of ratio greater than 0.67 (65%; 95% CI, 44-80 vs 25%; 95% CI, 0-60). CONCLUSIONS The described technique proved to be feasible, safe, and effective. Further investigation is needed.
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Mesini A, Moscatelli A, Castagnola E. Pertussis vaccination in pregnancy: how many pediatric hospitalizations could be prevented? MINERVA GINECOLOGICA 2019; 71:245-248. [PMID: 31089073 DOI: 10.23736/s0026-4784.19.04378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pertussis is a severe disease in children, especially in neonates and it is preventable by vaccination during pregnancy. After the observation of a 2-month-old toddler who needed extracorporeal membrane oxygenation for severe RSV plus Bordetella pertussis infection, we performed a review of all cases of pertussis admitted at the Istituto Giannina Gaslini, Genoa, Italy, from 2012 to 2018. We retrieved 72 cases of admission for pertussis, 46% aging less than 3 months, 42% with at least one comorbidity. Two patients needed ICU admission. Pertussis vaccination during pregnancy could contribute to reduce this burden of hospitalizations in youngest subjects.
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Comparing Percutaneous to Open Access for Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure. Pediatr Crit Care Med 2018; 19:981-991. [PMID: 30080776 PMCID: PMC6173194 DOI: 10.1097/pcc.0000000000001691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evaluate trends in method of access (percutaneous cannulation vs open cannulation) for pediatric extracorporeal membrane oxygenation and determine the effects of cannulation method on morbidity and mortality. DESIGN Retrospective cohort study. SETTING AND SUBJECTS The Extracorporeal Life Support Organization's registry was queried for pediatric patients on extracorporeal membrane oxygenation for respiratory failure from 2007 to 2015. INVERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to 70% (p < 0.001). Percutaneous cannulation patients were more commonly male (24.2% vs 21.5%; p = 0.01), older (average 7.6 vs 4.5 yr; p < 0.001), and heavier (average 33.0 vs 20.2 kg; p < 0.001). Subset analysis of patients on venovenous extracorporeal membrane oxygenation revealed higher rates of mechanical complications due to blood clots (28.9% vs 22.6%; p = 0.003) or cannula problems (18.9% vs 12.7%; p < 0.001), cannula site bleeding (25.3% vs 20.2%; p = 0.01) and increased rates of cannula site repair in the open cannulation cohort. Limb related complications were not significantly different on subset analysis for venovenous extracorporeal membrane oxygenation patients stratified by access site. Logistic regression analysis revealed that method of access was not associated with a difference in mortality. CONCLUSIONS The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique.
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Stiller B, Houmes RJ, Rüffer A, Kumpf M, Müller A, Kipfmüller F, Köditz H, Herber Jonat S, Schmoor C, Benk C, Tibboel D, Fleck T. Multicenter Experience With Mechanical Circulatory Support Using a New Diagonal Pump in 233 Children. Artif Organs 2017; 42:377-385. [PMID: 29193160 DOI: 10.1111/aor.13016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/12/2017] [Accepted: 07/24/2017] [Indexed: 11/26/2022]
Abstract
Technological innovations in pediatric extracorporeal life support circuits can reduce system-related complications and may improve patients' outcome. The Deltastream DP3 (Medos Medizintechnik AG, Stolberg, Germany) is a novel rotational pump with a diagonally streamed impeller that can be used over a broad range of flows. We collected patient data from seven pediatric centers to conduct a retrospective cohort study. We examined 233 patients whose median age was 1.9 (0-201) months. The DP3 system was used for cardiopulmonary support as veno-arterial extracorporeal membrane oxygenation (ECMO) in 162 patients. Respiratory support via veno-venous ECMO was provided in 63 patients. The pump was used as a ventricular assist device in eight patients. Median supporting time was 5.5 (0.2-69) days and the weaning rate was 72.5%. The discharge home rate was 62% in the pulmonary group versus 55% in the cardiac group. Extracorporeal cardiopulmonary resuscitation was carried out in 24 patients (10%) with a survival to discharge of rate of 37.5%. About 106 (47%) children experienced no complications, while 33% suffered bleeding requiring blood transfusion or surgical intervention. Three patients suffered a fatal cerebral event. Renal replacement therapy was performed in 28% and pump or oxygenator exchange in 26%. Multivariable analysis identified system exchange (OR 1.94), kidney failure (OR 3.43), and complications on support (OR 2.56) as risk factors for dismal outcome. This novel diagonal pump has demonstrated its efficacy in all kinds of mechanical circulatory and respiratory support, revealing good survival rates.
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Affiliation(s)
- Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Germany
| | - Robert Jan Houmes
- Intensive Care Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - André Rüffer
- Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University, Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Matthias Kumpf
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany
| | - Andreas Müller
- Department of Neonatology and Pediatric Critical Care, University Children's Hospital Bonn, Bonn, Germany
| | - Florian Kipfmüller
- Department of Neonatology and Pediatric Critical Care, University Children's Hospital Bonn, Bonn, Germany
| | - Harald Köditz
- Medical University Children's Hospital, Hannover, Germany
| | - Susanne Herber Jonat
- Division of Neonatology, Dr. von Hauner Children's Hospital, Perinatal Center Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Benk
- Department of Cardio-Vascular Surgery, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Freiburg, Germany
| | - Dick Tibboel
- Intensive Care Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Germany
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Duthie M. Management strategy during neonatal/paediatric VV ECMO run. Qatar Med J 2017. [PMCID: PMC5474601 DOI: 10.5339/qmj.2017.swacelso.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mark Duthie
- Sheikh Khalifa Medical City, Karama Street, PO Box 51900, Abu Dhabi City, UAE https://www.seha.ae/SKMC
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Moscatelli A, Pezzato S, Lista G, Petrucci L, Buratti S, Castagnola E, Tuo P. Venovenous ECMO for Congenital Diaphragmatic Hernia: Role of Ductal Patency and Lung Recruitment. Pediatrics 2016; 138:peds.2016-1034. [PMID: 27940774 DOI: 10.1542/peds.2016-1034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/24/2022] Open
Abstract
We report a case of antenatally diagnosed left-sided congenital diaphragmatic hernia, managed on venovenous extracorporeal membrane oxygenation with an hemodynamic and ventilation strategy aimed at preventing left and right ventricular dysfunction. Keeping the ductus arteriosus open with prostaglandin infusion and optimizing lung recruitment were effective in achieving hemodynamic stabilization and an ideal systemic oxygen delivery. The patient was discharged from the hospital and had normal development at 1 year of age. The combination of ductal patency and lung recruitment has not been previously reported as a strategy to stabilize congenital diaphragmatic hernia patients undergoing venovenous extracorporeal membrane oxygenation. We believe that this approach may deserve further evaluation in prospective studies.
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Affiliation(s)
- Andrea Moscatelli
- Neonatal and Pediatric ICU, Department of Critical Care and Perinatal Medicine, and
| | - Stefano Pezzato
- Neonatal and Pediatric ICU, Department of Critical Care and Perinatal Medicine, and
| | - Gianluca Lista
- Division of Neonatology, Vittore Buzzi Children's Hospital ICP, Milano, Italy
| | - Lara Petrucci
- Neonatal and Pediatric ICU, Department of Critical Care and Perinatal Medicine, and
| | - Silvia Buratti
- Neonatal and Pediatric ICU, Department of Critical Care and Perinatal Medicine, and
| | - Elio Castagnola
- Division of Infectious Diseases, Department of Pediatrics, Istituto Giannina Gaslini, Genova, Italy; and
| | - Pietro Tuo
- Neonatal and Pediatric ICU, Department of Critical Care and Perinatal Medicine, and
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