Marcus D Jarboe1, Samir K Gadepalli2, Joseph T Church2, Meghan A Arnold2, Ronald B Hirschl2, George B Mychaliska2. 1. Pediatric Surgery, Department of Surgery, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI, USA. Electronic address: marjarbo@med.umich.edu. 2. Pediatric Surgery, Department of Surgery, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI, USA.
Abstract
PURPOSE: The Avalon dual-lumen venovenous catheter has several advantages, but placement techniques and management have not been adequately addressed in the pediatric population. We assessed our institutional outcomes and complications using the Avalon catheter in children. METHODS: We reviewed all pediatric patients who had Avalon catheters placed for respiratory failure at our institution, excluding congenital heart disease patients, from April 2009 to March 2016. All patients were managed using our standard ECMO protocol, and cannula position was followed by daily chest x-ray and intermittent echocardiography (ECHO). Data included demographics, diagnosis, PRISM3 predicted mortality, ECMO duration, complications, and survival. The primary outcome was the need for catheter repositioning. RESULTS: Twenty-five patients were included, with mean age 8.3±6.9years and 15±22days of ECMO support. Overall survival was 68% (17/25). Fourteen patients (56%) underwent placement with fluoroscopy in addition to ultrasound and ECHO, primarily after 2013. Overall, thirteen patients (52%) had problems with cannula malposition. 9 of these (69%) required cannula repositioning. Three of 14 (21%) cannulas placed with fluoroscopy required repositioning, compared to 7/11 (64%) placed without fluoroscopy (p=0.05). CONCLUSIONS: Complications are common with the Avalon catheter in children. Safe percutaneous access requires ultrasound guidance, and use of intraoperative fluoroscopy in addition to echocardiography decreases malposition rates. LEVEL OF EVIDENCE: IV (Prognosis study).
PURPOSE: The Avalon dual-lumen venovenous catheter has several advantages, but placement techniques and management have not been adequately addressed in the pediatric population. We assessed our institutional outcomes and complications using the Avalon catheter in children. METHODS: We reviewed all pediatric patients who had Avalon catheters placed for respiratory failure at our institution, excluding congenital heart diseasepatients, from April 2009 to March 2016. All patients were managed using our standard ECMO protocol, and cannula position was followed by daily chest x-ray and intermittent echocardiography (ECHO). Data included demographics, diagnosis, PRISM3 predicted mortality, ECMO duration, complications, and survival. The primary outcome was the need for catheter repositioning. RESULTS: Twenty-five patients were included, with mean age 8.3±6.9years and 15±22days of ECMO support. Overall survival was 68% (17/25). Fourteen patients (56%) underwent placement with fluoroscopy in addition to ultrasound and ECHO, primarily after 2013. Overall, thirteen patients (52%) had problems with cannula malposition. 9 of these (69%) required cannula repositioning. Three of 14 (21%) cannulas placed with fluoroscopy required repositioning, compared to 7/11 (64%) placed without fluoroscopy (p=0.05). CONCLUSIONS: Complications are common with the Avalon catheter in children. Safe percutaneous access requires ultrasound guidance, and use of intraoperative fluoroscopy in addition to echocardiography decreases malposition rates. LEVEL OF EVIDENCE: IV (Prognosis study).
Authors: Vanessa Marie Bazan; Evan Michael Taylor; Tyler Michael Gunn; Joseph Bertram Zwischenberger Journal: Indian J Thorac Cardiovasc Surg Date: 2020-03-31
Authors: Ruslan Natanov; Abdurasul Khalikov; Faikah Gueler; Ulrich Maus; Erin C Boyle; Axel Haverich; Christian Kühn; Nodir Madrahimov Journal: Intensive Care Med Exp Date: 2019-12-16