Foley D S, Swaniker F, Pranikoff T, Bartlett R H, Hirschl R B
Department of Surgery, University of Michigan Hospitals, Ann Arbor 48109-0245, USA.
J Pediatr Surg. 2000 Jun;35(6):943-7. 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.
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).
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).
Percutaneous access may be used safely and effectively for venovenous ECLS in pediatric patients.
背景/目的：本研究的目的是证明一种经皮插管方法用于非新生儿（体重>10kg）儿科患者静脉-静脉体外生命支持（ECLS）通路的安全性和有效性。
1992年6月至1998年10月，26例儿科患者（年龄范围3至17岁；体重范围19至100kg）在我院尝试经皮插管进行静脉-静脉ECLS。尝试采用改良Seldinger技术经右颈内静脉（RIJ，n = 22）或右股静脉（RFV，n = 4）建立静脉引流通路。尝试经右股静脉（n = 19）、右颈内静脉（n = 4）或左股静脉（n = 3）建立再灌注通路。
26例患者中有24例（92.3%）经皮技术成功。ECLS期间的最大血流量为80.1±30.0 mL/kg/min，产生的膜后肺出口压力为138±54.8 mmHg。所有患者均实现了充分的气体交换，出院生存率为79.2%。无与操作相关的死亡。与经皮技术潜在相关的并发症包括拔管后检测到的右颈内静脉血栓形成（n = 1）和插管部位出血（n = 3）。
经皮通路可安全有效地用于儿科患者的静脉-静脉ECLS。
