From the Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
ASAIO J. 2019 Sep/Oct;65(7):636-641. doi: 10.1097/MAT.0000000000000884.
Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is a treatment strategy for pediatric patients with cardiopulmonary failure. Femoral cannulation is a commonly used technique for obtaining central access in children and adolescents despite high rates of vascular complications. Ischemic limb complications remain one of the most common problems facing survivors of femoral VA ECMO. Our aim is to review the literature on femoral cannulation in children and to present a review of techniques for femoral cannula placement, decannulation, and arterial repair to help minimize and ameliorate complications related to cannulation. We performed a literature review for pediatric ECMO cannulation, complications, and femoral artery repair in pediatric patients. We focused on the management of arterial and ischemia-related complications during and after ECMO support via femoral cannulation. Vascular complications are not infrequent for patients requiring ECMO support via femoral cannulation. As such, judicious distal perfusion monitoring as well as augmentation of distal flow are important strategies during mechanical support. The use of distal perfusion catheters can be used to minimize the risk of limb ischemia. As femoral cannulation grows more popular in pediatric patients, strategies for arterial repair are essential to ensure extremity perfusion upon decannulation.
静脉-动脉（VA）体外膜肺氧合（ECMO）是治疗心肺衰竭儿科患者的一种治疗策略。尽管血管并发症发生率较高，但股动脉置管仍是儿童获得中心通路的常用技术。缺血性肢体并发症仍然是股 VA ECMO 幸存者面临的最常见问题之一。我们的目的是回顾儿童股动脉置管的文献，并对股动脉置管、拔管和动脉修复技术进行综述，以帮助最小化和改善与置管相关的并发症。我们对儿科 ECMO 置管、并发症和儿童股动脉修复的文献进行了回顾。我们重点关注通过股动脉置管进行 ECMO 支持期间和之后与动脉和缺血相关的并发症的管理。对于需要通过股动脉置管进行 ECMO 支持的患者，血管并发症并不少见。因此，在机械支持期间，明智的远端灌注监测以及增加远端血流是重要的策略。使用远端灌注导管可最大程度地降低肢体缺血的风险。随着股动脉置管在儿科患者中越来越受欢迎，动脉修复策略对于确保拔管后肢体灌注至关重要。
