Prospective, randomized evaluation of the efficacy of fibrin sealant as a topical hemostatic agent at the cannulation site in neonates undergoing extracorporeal membrane oxygenation

Objectives: This study was designed to compare vascular complications and the outcomes of ultrasound (US)-guided percutaneous cannulation with distal perfusion catheter (PC-DP) and arterial side-graft perfusion (SGP) techniques in patients who require veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for refractory cardiogenic shock (RCS). Methods: We conducted a retrospective, observational cohort study of consequtive patients with RCS treated with VA-ECMO at a single transplant center from March 2010 until August 2015. Overall, 148 patients underwent VA-ECMO for RCS (99 men, aged 56.6 ± 12.0 years; BSA, 1.85 ± 0.19). Patients were categorized based on VA-ECMO perfusion technique into PC-DP via femoral artery and SGP via axillary/femoral artery groups. Results: The median duration of VA-ECMO support was 5 days (range, 8 hours–80 days). Hospital mortality (PC-DP group, 54.7%; SGP group, 64.4%; p=0.23) and overall ECMO survival (PC-DP group, 36.9%; SGP group, 32.2%; p=0.47) was similar between the groups. There were no significant between-group differences in the rate of acute limb ischemia (PC-DP group, 4/75, 5.3%; SGP group, 2/73, 2.7%; p=0.68). However, the rate of surgical/cannulation site bleeding (PC-DP, 9/75 (12%) vs SGP, 18/73 (24.7%), p=0.05) and hyperperfusion syndrome (PC-DP, 2/75 (2.7%) vs SGP, 22/73 (30.1%),p=0.001) were higher in the SGP group than in the PC-DP group. Conclusions: We observed no significant difference in major vascular complications or survival between patients who underwent the PC-DP technique and those who underwent arterial SGP.

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An Ovine Model of Awake Veno-Arterial Extracorporeal Membrane Oxygenation

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.809487 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jiachen Qi ◽

Sizhe Gao ◽

Gang Liu ◽

Shujie Yan ◽

Min Zhang ◽

...

Keyword(s):

Animal Models ◽

Extracorporeal Membrane Oxygenation ◽

Management Strategies ◽

Ecmo Support ◽

Large Animal ◽

Ovine Model ◽

Membrane Oxygenation ◽

Large Animal Models ◽

Cannulation Site ◽

Va Ecmo

Background: Large animal models are developed to help understand physiology and explore clinical translational significance in the continuous development of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) technology. The purpose of this study was to investigate the establishment methods and management strategies in an ovine model of VA-ECMO.Methods: Seven sheep underwent VA-ECMO support for 7 days by cannulation via the right jugular vein and artery. The animals were transferred into the monitoring cages after surgery and were kept awake after anesthesia recovery. The hydraulic parameters of ECMO, basic hemodynamics, mental state, and fed state of sheep were observed in real time. Blood gas analysis and activated clotting time (ACT) were tested every 6 h, while the complete blood count, blood chemistry, and coagulation tests were monitored every day. Sheep were euthanized after 7 days. Necropsy was performed and the main organs were removed for histopathological evaluation.Results: Five sheep survived and successfully weaned from ECMO. Two sheep died within 24–48 h of ECMO support. One animal died of fungal pneumonia caused by reflux aspiration, and the other died of hemorrhagic shock caused by bleeding at the left jugular artery cannulation site used for hemodynamic monitoring. During the experiment, the hemodynamics of the five sheep were stable. The animals stayed awake and freely ate hay and feed pellets and drank water. With no need for additional nutrition support or transfusion, the hemoglobin concentration and platelet count were in the normal reference range. The ECMO flow remained stable and the oxygenation performance of the oxygenator was satisfactory. No major adverse pathological injury occurred.Conclusions: The perioperative management strategies and animal care are the key points of the VA-ECMO model in conscious sheep. This model could be a platform for further research of disease animal models, pathophysiology exploration, and new equipment verification.

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Abstract 16208: Safety and Efficacy of Arterio-venous Extracorporeal Membrane Oxygenation (SAVE Study) Cannulation by Interventional Cardiologists for Pediatric Population: Results of a Single Center Pilot Study

Circulation ◽

10.1161/circ.142.suppl_3.16208 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Cihangir Buyukgoz ◽

Hitesh Sandhu ◽

Katherine Rower ◽

Benjamin Waller ◽

Umar Boston ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Extracorporeal Membrane Oxygenation ◽

Femoral Artery ◽

Tertiary Care ◽

Routine Practice ◽

Safety And Efficacy ◽

Membrane Oxygenation ◽

Vein Access ◽

Cannulation Site ◽

Va Ecmo

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulations have been successfully performed in adults by interventional cardiologists (IC) for cardiopulmonary resuscitation (CPR) but little data exists in children. Hypothesis: This study aimed to describe the safety and efficacy of ultrasound-guided percutaneous VA-ECMO cannulation performed by IC for cardiopulmonary resuscitation. Methods: VA-ECMO cannulation performed by IC for CPR between January 2018 - June 2020 in a tertiary care children’s hospital were reviewed. Efficacy was defined as successful initiation of VA-ECMO following CPR without a surgical cut-down. Safety was defined as the absence of the need for additional procedures related to the cannulation event. Results: Eight VA-ECMO cannulations were attempted on 7 patients with 100% success; 1 patient was cannulated twice at 2 separate CPR events. Patients had congenital heart disease (n=3), idiopathic pulmonary hypertension (n=1), T-cell lymphoma (n=1) and dilated cardiomyopathy (n=2). Median age was 15 (6-18) years, median weight was 74 (16-109) kg. Uninterrupted CPR occurred during all cannulations. All cannulations were performed from left femoral artery and right femoral vein, 4 (50%) cannulations included additional internal jugular vein access. Reperfusion cannulation for distal limb circulation was also performed percutaneously by IC for 5 cannulations. Median venous cannula size was 22 (15-25) Fr and median arterial cannula size was 17 (15-17) Fr. Median cannulation start time to ECMO flow was 34.5 (18-112) min. Median ECMO duration was 3 (0.3-50) days. Survival at ECMO decannulation was 75% with a 30-day survival of 87.5%. The overall complication rate was 12.5%. One patient developed hematoma at cannulation site that was conservatively managed, and 1 patient (16 kg) developed avulsion of the intima of the left common femoral artery that needed repair. A cardiovascular surgeon was available or present during all ECMO cannulations. Conclusions: Pediatric VA-ECMO cannulation for CPR can be performed safely and efficiently by IC without interruption. Larger studies and further investigations are necessary especially in smaller children before advocating for its routine practice.

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Influence of Cannulation Site on Carotid Perfusion During Extracorporeal Membrane Oxygenation in a Compliant Human Aortic Model

Annals of Biomedical Engineering ◽

10.1007/s10439-017-1875-8 ◽

2017 ◽

Vol 45 (10) ◽

pp. 2281-2297 ◽

Cited By ~ 6

Author(s):

Andreas Geier ◽

Andreas Kunert ◽

Günter Albrecht ◽

Andreas Liebold ◽

Markus Hoenicka

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Membrane Oxygenation ◽

Cannulation Site

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Rhabdomyolysis Due to Extracorporeal Membrane Oxygenation

Cardiothoracic Critical Care ◽

10.1093/med/9780190082482.003.0009 ◽

2020 ◽

pp. 97-110

Author(s):

Candice Metzinger ◽

Aaron LacKamp

Keyword(s):

Blood Flow ◽

Extracorporeal Membrane Oxygenation ◽

Muscle Injury ◽

Ischemia Reperfusion Injury ◽

Ischemia Reperfusion ◽

Membrane Oxygenation ◽

Peripheral Ischemia ◽

Cannulation Site ◽

Cannulation Technique ◽

Ischemic Muscle

This chapter studies rhabdomyolysis due to extracorporeal membrane oxygenation (ECMO). Rhabdomyolysis and ischemic muscle injury may result in renal failure, loss of limb, and even death due to hyperkalemia and acidosis. The first step is to identify the cause of the muscle injury. The sheer size of ECMO arterial cannulae can cause decreased blood flow distal to cannula, especially in patients with small-caliber arteries. However, decreased blood flow may also be a manifestation of the technique used to cannulate the artery. Thus, knowledge of the type of cannulation access is required in order to ascertain if ischemia is likely due to the cannulation technique and to evaluate strategies to revise or replace the cannulation site. The chapter then considers the various techniques used to acquire femoral arterial cannulation for ECMO, which may vary in the risk of peripheral ischemia. Other potential sources of peripheral ischemic injury are ischemia due to reperfusion, ischemia–reperfusion injury, and arterial emboli. The chapter also addresses the treatment of rhabdomyolysis, the major goal of which is the prevention of acute kidney failure.

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