Venogram before long-interval repeat cannulation for pediatric extracorporeal membrane oxygenation

Perfusion ◽  
2020 ◽  
pp. 026765912092535
Author(s):  
Benjamin D Carr ◽  
Joseph Kohne ◽  
Matthew W Ralls ◽  
Peter Sassalos ◽  
Richard G Ohye ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Male Patient ◽  
Jugular Vein ◽  
Membrane Oxygenation ◽  
Vein Occlusion ◽  
Central Cannulation ◽  
To Receive ◽  
Safe Access ◽  
Multiple Episodes

It is rare for children to receive more than one course of support with extracorporeal membrane oxygenation, and in those who do undergo multiple episodes, the interval is usually days to weeks between events. Little data exists on re-cannulation years after an initial extracorporeal membrane oxygenation run, and late repeat cannulation can pose unique challenges. We report the case of a 10-year-old male patient with right jugular vein occlusion due to a previous course of extracorporeal membrane oxygenation as a neonate, who was successfully supported via central cannulation. This case demonstrates the importance of adequate imaging of target vasculature prior to attempting re-cannulation of a previously used vessel. Establishing a thoughtful strategy for late repeat cannulation is essential to achieve safe access in unusual and challenging situations.

Outcomes of Venoarterial Extracorporeal Membrane Oxygenation Patients Requiring Multiple Episodes of Support

2020 ◽  
Vol 34 (9) ◽  
pp. 2357-2361 ◽  
Author(s):  
Yvonne Lai ◽  
Jamel Ortoleva ◽  
Mauricio Villavicencio ◽  
David D'Alessandro ◽  
Ken Shelton ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Multiple Episodes

Characterization of Extracorporeal Membrane Oxygenation Support for Single Ventricle Patients

2020 ◽  
Vol 11 (2) ◽  
pp. 183-191
Author(s):  
Elizabeth H. Stephens ◽  
Aqsa Shakoor ◽  
Shimon E. Jacobs ◽  
Shunpei Okochi ◽  
Ariela L. Zenilman ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Single Ventricle ◽  
Early Recognition ◽  
Orthotopic Heart Transplantation ◽  
Factors Associated ◽  
Membrane Oxygenation ◽  
End Point ◽  
Thrombotic Complications ◽  
Central Cannulation

Background: Extracorporeal membrane oxygenation (ECMO) can provide crucial support for single ventricle (SV) patients at various stages of palliation. However, characterization of the utilization and outcomes of ECMO in these unique patients remains incompletely studied. Methods: We performed a single-center retrospective review of SV patients between 2010 and 2017 who underwent ECMO cannulation with primary end point of survival to discharge and secondary end point of survival to decannulation or orthotopic heart transplantation (OHT). Multivariate analysis was performed for factors predictive of survival to discharge and survival to decannulation. Results: Forty SV patients with a median age of one month (range: 3 days to 15 years) received ECMO support. The incidence of ECMO was 14% for stage I, 3% for stage II, and 4% for stage III. Twenty-seven (68%) patients survived to decannulation, and 21 (53%) patients survived to discharge, with seven survivors to discharge undergoing OHT. Complications included infection (40%), bleeding (40%), thrombosis (33%), and radiographic stroke (45%). Factors associated with survival to decannulation included pre-ECMO lactate (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.41-0.90, P = .013) and post-ECMO bicarbonate (HR: 1.24, 95% CI: 1.0-1.5, P = .018). Factors associated with survival to discharge included central cannulation (HR: 40.0, 95% CI: 3.1-500.0, P = .005) and lack of thrombotic complications (HR: 28.7, 95% CI: 2.1-382.9, P = .011). Conclusions: Extracorporeal membrane oxygenation can be useful to rescue SV patients with approximately half surviving to discharge, although complications are frequent. Early recognition of the role of heart transplant is imperative. Further study is required to identify areas for improvement in this population.

Morbidity for Survivors of Extracorporeal Membrane Oxygenation: Neurodevelopmental Outcome at 1 Year of Age

PEDIATRICS ◽  
1989 ◽  
Vol 83 (1) ◽  
pp. 72-78
Author(s):  
Penny Glass ◽  
Marilea Miller ◽  
Billie Short
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Extracorporeal Membrane Oxygenation ◽  
Jugular Vein ◽  
Long Term Outcome ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support ◽  
High Risk Infants ◽  
The Right

Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infants whose long-term outcome is being followed prospectively at our institution. The extracorporeal membrane oxygenation procedure allows temporary cardiopulmonary support for critically ill full-term neonates who are refractory to maximum ventilatory and medical management as a consequence of severe persistent pulmonary hypertension. The technique necessitates both the permanent ligation of the right common carotid artery and jugular vein and systemic heparinization. The survivors constitute a unique group of high-risk infants, from the standpoint of the hypoxic-ischemic insults preceding extracorporeal membrane oxygenation and the risks associated with the procedure. Our results indicate that most of our survivors are developing normally at 1 year. Major morbidity, in terms of either significant developmental delay (Bayley mental and motor indices less than 70) or significant neuromotor abnormality, occurred in only 10% of these infants. Poor outcome was associated with major intracranial hemorrhage and chronic lung disease. Ligation of the right carotid artery and jugular vein was not associated with a consistent lateralizing lesion. Long-term follow-up through school age is essential.

Veno-venous extracorporeal membrane oxygenation using an innovative dual-lumen cannula following implantation of a total artificial heart

Perfusion ◽  
2016 ◽  
Vol 32 (1) ◽  
pp. 81-83
Author(s):  
Jemma Youdle ◽  
Sarah Penn ◽  
Olaf Maunz ◽  
Andre Simon
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Male Patient ◽  
Artificial Heart ◽  
Life Support ◽  
Total Artificial Heart ◽  
Clinical Use ◽  
Respiratory Dysfunction ◽  
Membrane Oxygenation ◽  
Biventricular Failure

We report our first clinical use of the new Protek DuoTM cannula for peripheral veno-venous extra-corporeal life support (ECLS). A 53-year-old male patient underwent implantation of a total artificial heart (TAH) for biventricular failure. However, due to the development of post-operative respiratory dysfunction, the patient required ECLS for six days.

Peripheral cannulation for extracorporeal membrane oxygenation yields superior neurologic outcomes in adult patients who experienced cardiac arrest following cardiac surgery

Perfusion ◽  
2021 ◽  
pp. 026765912110181
Author(s):  
Lauren E Levy ◽  
David J Kaczorowski ◽  
Chetan Pasrija ◽  
Gregory Boyajian ◽  
Michael Mazzeffi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Cause Of Death ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Neurologic Outcomes ◽  
Va Ecmo ◽  
Central Cannulation ◽  
Post Cardiac Surgery

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest has improved mortality in post-cardiac surgery patients; however, loss of neurologic function remains one of the main and devastating complications. We reviewed our experience with ECPR and investigated the effect of cannulation strategy on neurologic outcome in adult patients who experienced cardiac arrest following cardiac surgery that was managed with ECPR. Methods: Patients were categorized by central versus percutaneous peripheral VA-extracorporeal membrane oxygenation (ECMO) cannulation strategy. We reviewed patient records and evaluated in-hospital mortality, cause of death, and neurologic status 72 hours after cannulation. Results: From January 2010 to September 2019, 44 patients underwent post-cardiac surgery ECPR for cardiac arrest. Twenty-six patients received central cannulation; 18 patients received peripheral cannulation. Mean post-operative day of the cardiac arrest was 3 and 9 days (p = 0.006), and mean time between initiation of CPR and ECMO was 40 ± 24 and 28 ± 22 minutes for central and peripheral cannulation, respectively. After 72 hours of VA-ECMO support, 30% of centrally cannulated patients versus 72% of peripherally cannulated patients attained cerebral performance status 1–2 (p = 0.01). Anoxic brain injury was the cause of death in 26.9% of centrally cannulated and 11.1% of peripherally cannulated patients. Survival to discharge was 31% and 39% for central and peripheral cannulation, respectively. Conclusions: Peripheral VA-ECMO allows for continuous CPR and systemic perfusion while obtaining vascular access. Compared to central cannulation, a peripheral cannulation strategy is associated with improved neurologic outcomes and decreased likelihood of anoxic brain death.

scholarly journals Superior vena cava syndrome during veno-venous extracorporeal membrane oxygenation for COVID-19

Perfusion ◽  
2021 ◽  
pp. 026765912098797
Author(s):  
Rafal Kopanczyk ◽  
Omar H Al-Qudsi ◽  
Asvin M Ganapathi ◽  
Bethany R Potere ◽  
Paul S Pagel
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Membrane Oxygenation ◽  
Svc Syndrome ◽  
The Right ◽  
Vv Ecmo

Superior vena cava (SVC) syndrome is typically associated with malignant tumors obstructing the SVC, but as many as 40% of cases have other etiologies. SVC obstruction was previously described during veno-venous extracorporeal membrane oxygenation therapy (VV ECMO) in children. In this report, we describe a woman with adult respiratory distress syndrome resulting from infection with coronavirus-19 who developed SVC syndrome during VV ECMO. A dual-lumen ECMO cannula was inserted in the right internal jugular vein, but insufficient ECMO circuit flow, upper body edema, and signs of hypovolemic shock were observed. This clinical picture resolved when the right internal jugular vein was decannulated in favor of bilateral femoral venous cannulae. Our report demonstrates that timely recognition of clinical signs and symptoms led to the appropriate diagnosis of an uncommon ECMO complication.

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