Division of Pediatric Cardiology, LeBonheur Children's Hospital, University of Tennessee, Memphis, Tennessee, USA.
Division of Pediatric Critical Care Medicine, LeBonheur Children's Hospital, University of Tennessee, Memphis, Tennessee, USA.
Catheter Cardiovasc Interv. 2023 May;101(6):1088-1097. doi: 10.1002/ccd.30649. Epub 2023 Mar 30.
To describe the techniques used for percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation and decannulation in children with the pediatric interventional cardiologist (PIC) as the primary operator, and present outcomes of this initial clinical experience.
Percutaneous VA-ECMO during cardiopulmonary resuscitation (CPR) has been successfully performed in adults, but currently, not much data exists on children.
This is a single-center study including VA-ECMO cannulations performed by the PIC between 2019 and 2021. Efficacy was defined as the successful initiation of VA-ECMO without surgical cutdown. Safety was defined as the absence of additional procedures related to cannulation.
Twenty-three percutaneous VA-ECMO cannulations were performed by PIC on 20 children with 100% success. Fourteen (61%) were performed during ongoing CPR, and nine for cardiogenic shock. The Median age was 15 (0.15-18) years, and the median weight was 65 (3.3-180) kg. All arterial cannulations were via the femoral artery except in one, 8-week-old infant who was cannulated in the carotid artery. A distal perfusion cannula was placed in the ipsilateral limb in 17 (78%). The median time from initiating cannulation to ECMO flow was 35 (13-112) minutes. Two patients required arterial graft placement at the time of decannulation and one needed below-knee amputation. ECMO support was maintained for a median of 4 (0.3-38) days. Thirty-day survival was 74%.
Percutaneous VA-ECMO cannulations can be effectively performed, even during CPR with the Pediatric Interventional Cardiologist being the primary operator. This is an initial clinical experience. Future outcome studies compared with standard surgical cannulations are necessary to advocate routine percutaneous VA-ECMO in children.
描述由儿科介入心脏病专家（PIC）作为主要操作者进行儿童经皮动静脉体外膜肺氧合（VA-ECMO）置管和拔管的技术，并介绍这一初步临床经验的结果。
心肺复苏（CPR）期间的经皮 VA-ECMO 已在成人中成功实施，但目前儿童的数据并不多。
这是一项单中心研究，纳入了 2019 年至 2021 年期间由 PIC 进行的 VA-ECMO 置管。疗效定义为成功启动 VA-ECMO 而无需手术切开。安全性定义为无与置管相关的其他程序。
PIC 对 20 名儿童进行了 23 例经皮 VA-ECMO 置管，成功率为 100%。14 例（61%）在持续 CPR 期间进行，9 例用于心源性休克。中位年龄为 15 岁（0.15-18 岁），中位体重为 65 公斤（3.3-180 公斤）。所有动脉置管均通过股动脉进行，除了一名 8 周大的婴儿通过颈动脉进行置管。17 例（78%）在同侧肢体中放置了远端灌注插管。从开始置管到 ECMO 血流的中位时间为 35 分钟（13-112 分钟）。2 例患者在拔管时需要放置动脉移植物，1 例需要膝下截肢。中位 ECMO 支持时间为 4 天（0.3-38 天）。30 天存活率为 74%。
即使由儿科介入心脏病专家作为主要操作者，也可以有效地进行经皮 VA-ECMO 置管，甚至在 CPR 期间也是如此。这是初步的临床经验。未来需要与标准手术置管进行的预后研究来倡导在儿童中常规进行经皮 VA-ECMO。
