Hong Joon Ahn1, Jun Wan Lee2, Ki Hyuk Joo3, Yeon Ho You3, Seung Ryu3, Jin Woong Lee3, Seung Whan Kim3. 1. Surgical Intensive Care Unit, Chungnam National University Hospital, Daejeon, Korea. 2. Emergency Intensive Care Unit, Regional Emergency Center, Chungnam National University Hospital, Daejeon, Korea. 3. Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea.
Abstract
BACKGROUND: Cannulation of the great vessels is required for extracorporeal membrane oxygenation (ECMO). Currently, there is no guideline for optimal imaging modalities during percutaneous cannulation of ECMO. OBJECTIVE: The purpose of this study was to describe percutaneous cannulation guided by point-of-care ultrasound (POCUS) for ECMO and compare it with fluoroscopy and landmark guidance. METHODS: Three groups (POCUS-, fluoroscopy-, and landmark-guided) of percutaneous cannulation for ECMO were analyzed retrospectively in a tertiary academic hospital. In the POCUS-guided group, visual confirmation of guidewire and cannula by ultrasound in both the access and return cannula were essential for successful cannulation. Fluoroscopy- and landmark-guided groups were cannulated with the conventional technique. RESULTS: A total of 128 patients were treated by ECMO during the study period, of which 94 (73.4%) cases were venoarterial ECMO. This included 56 cases of extracorporeal cardiopulmonary resuscitation. Also, there were 30 (23.4%) cases of venovenous ECMO and 4 (3.1%) cases of venoarteriovenous ECMO. A total of 71 (55.5%) patients were cannulated under POCUS guidance, and 43 (33.6%) patients were cannulated under fluoroscopy guidance and 14 (10.9%) patients were cannulated by landmark guidance. No surgical cut downs were required. Misplacement of cannula occurred in 3 (2.3%) cases. All three occurred in the landmark-guided group. CONCLUSIONS: POCUS-guided cannulation is comparable to fluoroscopy-guided cannulation in terms of avoiding cannula misplacement. In our experience, POCUS-guided cannulation is a useful strategy over fluoroscopy- and landmark-guided cannulation during peripheral ECMO.
BACKGROUND: Cannulation of the great vessels is required for extracorporeal membrane oxygenation (ECMO). Currently, there is no guideline for optimal imaging modalities during percutaneous cannulation of ECMO. OBJECTIVE: The purpose of this study was to describe percutaneous cannulation guided by point-of-care ultrasound (POCUS) for ECMO and compare it with fluoroscopy and landmark guidance. METHODS: Three groups (POCUS-, fluoroscopy-, and landmark-guided) of percutaneous cannulation for ECMO were analyzed retrospectively in a tertiary academic hospital. In the POCUS-guided group, visual confirmation of guidewire and cannula by ultrasound in both the access and return cannula were essential for successful cannulation. Fluoroscopy- and landmark-guided groups were cannulated with the conventional technique. RESULTS: A total of 128 patients were treated by ECMO during the study period, of which 94 (73.4%) cases were venoarterial ECMO. This included 56 cases of extracorporeal cardiopulmonary resuscitation. Also, there were 30 (23.4%) cases of venovenous ECMO and 4 (3.1%) cases of venoarteriovenous ECMO. A total of 71 (55.5%) patients were cannulated under POCUS guidance, and 43 (33.6%) patients were cannulated under fluoroscopy guidance and 14 (10.9%) patients were cannulated by landmark guidance. No surgical cut downs were required. Misplacement of cannula occurred in 3 (2.3%) cases. All three occurred in the landmark-guided group. CONCLUSIONS: POCUS-guided cannulation is comparable to fluoroscopy-guided cannulation in terms of avoiding cannula misplacement. In our experience, POCUS-guided cannulation is a useful strategy over fluoroscopy- and landmark-guided cannulation during peripheral ECMO.
Authors: Guido Michels; Tobias Wengenmayer; Christian Hagl; Christian Dohmen; Bernd W Böttiger; Johann Bauersachs; Andreas Markewitz; Adrian Bauer; Jan-Thorsten Gräsner; Roman Pfister; Alexander Ghanem; Hans-Jörg Busch; Uwe Kreimeier; Andreas Beckmann; Matthias Fischer; Clemens Kill; Uwe Janssens; Stefan Kluge; Frank Born; Hans Martin Hoffmeister; Michael Preusch; Udo Boeken; Reimer Riessen; Holger Thiele Journal: Clin Res Cardiol Date: 2018-09-04 Impact factor: 5.460
Authors: G Michels; T Wengenmayer; C Hagl; C Dohmen; B W Böttiger; J Bauersachs; A Markewitz; A Bauer; J-T Gräsner; R Pfister; A Ghanem; H-J Busch; U Kreimeier; A Beckmann; M Fischer; C Kill; U Janssens; S Kluge; F Born; H M Hoffmeister; M Preusch; U Boeken; R Riessen; H Thiele Journal: Med Klin Intensivmed Notfmed Date: 2018-09 Impact factor: 0.840
Authors: G Michels; T Wengenmayer; C Hagl; C Dohmen; B W Böttiger; J Bauersachs; A Markewitz; A Bauer; J-T Gräsner; R Pfister; A Ghanem; H-J Busch; U Kreimeier; A Beckmann; M Fischer; C Kill; U Janssens; S Kluge; F Born; H M Hoffmeister; M Preusch; U Boeken; R Riessen; H Thiele Journal: Anaesthesist Date: 2018-08 Impact factor: 1.041
Authors: Patrick T Hussey; Gregory von Mering; Navin C Nanda; Mustafa I Ahmed; Dylan R Addis Journal: Echocardiography Date: 2022-01-07 Impact factor: 1.874