Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Perinatol. 2021 Jul;41(7):1645-1650. doi: 10.1038/s41372-021-00936-8. Epub 2021 Apr 1.
To assess the ability of point-of-care ultrasound (POCUS) to identify venous cannula position in neonates on extracorporeal membrane oxygenation (ECMO) and compare with conventional imaging.
Retrospective review of 37 infants on ECMO with 51 POCUS studies between January 2017 and October 2019. Studies were reviewed for identification of venous cannula location and compared with plain radiography and echocardiography. Kappa statistic and predictive values were calculated.
Venous cannula tip position was identified in 90% of POCUS studies. Fifty percent of the cannula tips were malpositioned. Plain radiography, the most commonly used method for evaluating tip position, showed poor agreement (57%) with POCUS (kappa 0.13). There was substantial agreement (89%) between echocardiography and POCUS (kappa 0.78).
This study provides preliminary evidence that POCUS is more accurate than plain radiography for the evaluation of ECMO venous cannula position. Adoption of this practice may prevent potentially catastrophic ECMO complications.
评估床边超声（POCUS）在体外膜肺氧合（ECMO）新生儿中识别静脉插管位置的能力，并与传统影像学方法进行比较。
回顾性分析 2017 年 1 月至 2019 年 10 月期间 37 名 ECMO 患儿的 51 项 POCUS 研究。评估静脉插管位置，并与平片和超声心动图进行比较。计算 Kappa 统计量和预测值。
90%的 POCUS 研究中可以识别静脉插管尖端位置。50%的插管尖端位置不良。平片是评估尖端位置最常用的方法，与 POCUS 的一致性较差（57%）（kappa 值为 0.13）。超声心动图与 POCUS 之间有很高的一致性（89%）（kappa 值为 0.78）。
这项研究初步表明，POCUS 比平片更能准确评估 ECMO 静脉插管位置。采用这种方法可能会预防潜在的灾难性 ECMO 并发症。
