Jarboe Marcus D, Gadepalli Samir K, Church Joseph T, Arnold Meghan A, Hirschl Ronald B, Mychaliska George B
Pediatric Surgery, Department of Surgery, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI, USA.
Pediatric Surgery, Department of Surgery, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI, USA.
J Pediatr Surg. 2017 Oct 12. doi: 10.1016/j.jpedsurg.2017.10.036.
The Avalon dual-lumen venovenous catheter has several advantages, but placement techniques and management have not been adequately addressed in the pediatric population. We assessed our institutional outcomes and complications using the Avalon catheter in children.
We reviewed all pediatric patients who had Avalon catheters placed for respiratory failure at our institution, excluding congenital heart disease patients, from April 2009 to March 2016. All patients were managed using our standard ECMO protocol, and cannula position was followed by daily chest x-ray and intermittent echocardiography (ECHO). Data included demographics, diagnosis, PRISM3 predicted mortality, ECMO duration, complications, and survival. The primary outcome was the need for catheter repositioning.
Twenty-five patients were included, with mean age 8.3±6.9years and 15±22days of ECMO support. Overall survival was 68% (17/25). Fourteen patients (56%) underwent placement with fluoroscopy in addition to ultrasound and ECHO, primarily after 2013. Overall, thirteen patients (52%) had problems with cannula malposition. 9 of these (69%) required cannula repositioning. Three of 14 (21%) cannulas placed with fluoroscopy required repositioning, compared to 7/11 (64%) placed without fluoroscopy (p=0.05).
Complications are common with the Avalon catheter in children. Safe percutaneous access requires ultrasound guidance, and use of intraoperative fluoroscopy in addition to echocardiography decreases malposition rates.
IV (Prognosis study).
Avalon双腔静脉导管有诸多优点，但在儿科患者中其置入技术和管理方法尚未得到充分探讨。我们评估了在儿童中使用Avalon导管的机构治疗效果及并发症情况。
我们回顾了2009年4月至2016年3月期间在我院因呼吸衰竭而置入Avalon导管的所有儿科患者，不包括先天性心脏病患者。所有患者均按照我们的标准体外膜肺氧合（ECMO）方案进行管理，通过每日胸部X线检查和间歇性超声心动图（ECHO）来监测插管位置。数据包括人口统计学资料、诊断、PRISM3预测死亡率、ECMO持续时间、并发症及生存情况。主要结局是导管重新定位的必要性。
纳入25例患者，平均年龄8.3±6.9岁，接受ECMO支持的时间为15±22天。总体生存率为68%（17/25）。14例患者（56%）除了超声和ECHO外，还在透视引导下进行了置管，主要是在2013年之后。总体而言，13例患者（52%）存在插管位置不当的问题。其中9例（69%）需要重新定位插管。在透视引导下置入的14根插管中有3根（21%）需要重新定位，而未使用透视引导置入的11根插管中有7根（64%）需要重新定位（p=0.05）。
儿童使用Avalon导管时并发症很常见。安全的经皮穿刺需要超声引导，除了超声心动图外，术中使用透视可降低位置不当的发生率。
IV（预后研究）。
