Sarah B Cairo1, Mary Arbuthnot2, Laura Boomer3, Michael W Dingeldein4, Alexander Feliz5, Samir Gadepalli6, Christopher R Newton7, Pramod Puligandla8, Robert Ricca9, Peter Rycus10, Adam M Vogel11, Guan Yu12, Ziqiang Chen12, David H Rothstein1,13. 1. Department of Pediatric Surgery, John R Oishei Children's Hospital, Buffalo, NY. 2. Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA. 3. Department of Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA. 4. Department of Pediatric Surgery, Rainbow Babies and Children Hospital, Cleveland, OH. 5. Department of Pediatric Surgery, University of Tennessee Health Sciences, Memphis, TN. 6. Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI. 7. Department of Pediatric Surgery, University of California at San Francisco Benioff Children's Hospital Oakland, San Francisco, CA. 8. Department of Pediatric Surgery, Montreal Children's Hospital, Montréal, QC, Canada. 9. Department of Pediatric and General Surgery, Naval Medical Center Portsmouth, Portsmouth, VA. 10. Extracorporeal Life Support Organization, Ann Arbor, MI. 11. Department of Pediatric General Surgery, Texas Children's Hospital, Houston, TX. 12. Department of Biostatistics, State University of New York, University at Buffalo, Buffalo, NY. 13. Department of Surgery, State University of New York, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
Abstract
OBJECTIVES: Evaluate trends in method of access (percutaneous cannulation vs open cannulation) for pediatric extracorporeal membrane oxygenation and determine the effects of cannulation method on morbidity and mortality. DESIGN: Retrospective cohort study. SETTING AND SUBJECTS: The Extracorporeal Life Support Organization's registry was queried for pediatric patients on extracorporeal membrane oxygenation for respiratory failure from 2007 to 2015. INVERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to 70% (p < 0.001). Percutaneous cannulation patients were more commonly male (24.2% vs 21.5%; p = 0.01), older (average 7.6 vs 4.5 yr; p < 0.001), and heavier (average 33.0 vs 20.2 kg; p < 0.001). Subset analysis of patients on venovenous extracorporeal membrane oxygenation revealed higher rates of mechanical complications due to blood clots (28.9% vs 22.6%; p = 0.003) or cannula problems (18.9% vs 12.7%; p < 0.001), cannula site bleeding (25.3% vs 20.2%; p = 0.01) and increased rates of cannula site repair in the open cannulation cohort. Limb related complications were not significantly different on subset analysis for venovenous extracorporeal membrane oxygenation patients stratified by access site. Logistic regression analysis revealed that method of access was not associated with a difference in mortality. CONCLUSIONS: The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique.
OBJECTIVES: Evaluate trends in method of access (percutaneous cannulation vs open cannulation) for pediatric extracorporeal membrane oxygenation and determine the effects of cannulation method on morbidity and mortality. DESIGN: Retrospective cohort study. SETTING AND SUBJECTS: The Extracorporeal Life Support Organization's registry was queried for pediatric patients on extracorporeal membrane oxygenation for respiratory failure from 2007 to 2015. INVERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to 70% (p < 0.001). Percutaneous cannulation patients were more commonly male (24.2% vs 21.5%; p = 0.01), older (average 7.6 vs 4.5 yr; p < 0.001), and heavier (average 33.0 vs 20.2 kg; p < 0.001). Subset analysis of patients on venovenous extracorporeal membrane oxygenation revealed higher rates of mechanical complications due to blood clots (28.9% vs 22.6%; p = 0.003) or cannula problems (18.9% vs 12.7%; p < 0.001), cannula site bleeding (25.3% vs 20.2%; p = 0.01) and increased rates of cannula site repair in the open cannulation cohort. Limb related complications were not significantly different on subset analysis for venovenous extracorporeal membrane oxygenation patients stratified by access site. Logistic regression analysis revealed that method of access was not associated with a difference in mortality. CONCLUSIONS: The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique.
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