Shah Nikhil R, Spencer Brianna L, Maselli Kathryn M, Williams Keyonna M, Sood Vikram, Gadepalli Samir K, Thirumoorthi Arul S
Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA.
Congenital Heart Center, Section of Pediatric Cardiovascular Surgery, C.S. Mott Children's Hospital, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA.
Perfusion. 2024 Nov;39(8):1692-1699. doi: 10.1177/02676591231216326. Epub 2023 Nov 17.
Extracorporeal membrane oxygenation cannulation strategies vary between adults and children. Femoral approach is common in adults and extremity morbidity is well-documented. Aside from limb ischemia, complications in children are theorized and have yet to be studied. This study aims to comprehensively evaluate implications of pediatric femoral cannulation.
This is a single-center retrospective review of children <21 years, undergoing femoral venoarterial (VA) or venovenous (VV) cannulation between 2015 and 2022. The primary outcome was incidence of lower extremity complications on ECMO (groin hematoma/hemorrhage, vascular thrombosis, North-South syndrome, compartment syndrome, limb loss). Secondary outcome was incidence of post-decannulation extremity complications (pseudoaneurysm, surgical site infection, vascular thrombosis, motor/sensory deficits).
29 children were cannulated via femoral approach. Most required VA support (89%). Common sites were right femoral artery (70.8%) and right femoral vein (56%). 18 patients (75%) had distal reperfusion cannulas (DPC) placed. Short-term lower extremity complication rate was 59%, most frequently groin hematoma/hemorrhage (30%) and North-South syndrome (19%). Compartment syndrome occurred in 3 patients (11%), though none suffered digit/limb loss. There were no significant differences in complications between cannulation approach (open vs percutaneous) or vessel laterality (ipsilateral vs contralateral). Of those decannulated ( = 15), median ECMO duration was 8 days. Following decannulation, 20% suffered pseudoaneurysm. Ten (63%) experienced ipsilateral motor weakness which resolved in 50% of patients at 1-month follow-up; 20% suffered sensory deficits all resolving by discharge.
Approximately one third of children who underwent femoral cannulation suffered groin hematoma/hemorrhage and nearly 20% experienced North-South syndrome. Following decannulation, most had extremity weakness while sensory deficits were rarer. This marked risk of extremity morbidity prompts proactive inpatient monitoring and close surveillance after discharge.
体外膜肺氧合（ECMO）插管策略在成人和儿童之间有所不同。股动脉途径在成人中很常见，肢体发病率已有充分记录。除了肢体缺血外，儿童的并发症只是理论上存在，尚未得到研究。本研究旨在全面评估小儿股动脉插管的影响。
这是一项对2015年至2022年间接受股动静脉（VA）或股静脉-静脉（VV）插管的21岁以下儿童进行的单中心回顾性研究。主要结局是ECMO期间下肢并发症的发生率（腹股沟血肿/出血、血管血栓形成、南北综合征、骨筋膜室综合征、肢体缺失）。次要结局是拔管后肢体并发症的发生率（假性动脉瘤、手术部位感染、血管血栓形成、运动/感觉障碍）。
29名儿童通过股动脉途径插管。大多数需要VA支持（89%）。常见部位是右股动脉（70.8%）和右股静脉（56%）。18例患者（75%）放置了远端再灌注插管（DPC）。短期下肢并发症发生率为59%，最常见的是腹股沟血肿/出血（30%）和南北综合征（19%）。3例患者（11%）发生骨筋膜室综合征，尽管没有一例出现手指/肢体缺失。插管方法（开放与经皮）或血管侧别（同侧与对侧）之间的并发症无显著差异。在拔管的患者中（n = 15），ECMO的中位持续时间为8天。拔管后，20%的患者发生假性动脉瘤。10例（63%）出现同侧运动无力，其中50%的患者在1个月随访时恢复；20%的患者出现感觉障碍，所有患者在出院时均已恢复。
接受股动脉插管的儿童中约有三分之一发生腹股沟血肿/出血，近20%的儿童出现南北综合征。拔管后，大多数患者出现肢体无力，而感觉障碍较少见。这种明显的肢体发病风险促使在住院期间进行积极监测，并在出院后进行密切随访。
