Salazar Paul A, Blitzer David, Dolejs Scott C, Parent John J, Gray Brian W
Indiana University School of Medicine, Department of Surgery, Section of Pediatric Surgery, Indianapolis, Indiana.
Indiana University School of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Indianapolis, Indiana.
J Surg Res. 2018 Dec;232:517-523. doi: 10.1016/j.jss.2018.07.030. Epub 2018 Aug 3.
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.
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-).
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.
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.
传统上，颈内静脉体外膜肺氧合（ECMO）插管位置通过X线平片确定。插管位置不当可能导致需要重新定位并增加发病率。在插管过程中，可使用超声心动图（ECHO）作为指导插管位置的更准确方法。本研究回顾了一项鼓励在插管时使用ECHO的方案的效果。
对接受颈静脉插管进行ECMO支持的患者进行单机构回顾性研究。我们将插管时接受ECHO检查的患者（ECHO+）与未接受ECHO检查的患者（ECHO-）进行了比较。
纳入89例患者：26例ECHO+，63例ECHO-。大多数ECHO+患者接受双腔静脉-静脉（VV）插管（65%）；32%的ECHO-患者接受VV支持（P = 0.003）。两组插管重新定位率无差异：ECHO+组为8%，ECHO-组为10%，P = 0.78。在VV ECMO亚组中，ECHO+患者无需重新定位（0/17），而ECHO- VV患者中有20%（4/20）需要重新定位（P = 0.10）。插管后，ECHO+组患者平均进行0.58次ECHO检查以确认插管位置，而ECHO-组为0.22次（P = 0.02）。每组均发生1例主要机械并发症：ECHO+组为插管时导丝导致的心房穿孔，ECHO-组为松动插管导致的晚期心房穿孔，两组次要并发症无差异。
在新生儿和儿童颈内静脉插管进行ECMO时，ECHO引导并未降低发病率或减少插管重新定位的需求。ECHO对于双腔VV插管的精确放置以及困难插管过程中仍可能是有用的辅助手段。
