COMPLICATED CANNULA INSERTIONS AND CANNULA DISLODGMENTS ASSOCIATED WITH EXTRACORPOREAL MEMBRANE-OXYGENATION

Extracorporeal membrane oxygenation therapy remains a life saving moda lity for neonates with cardiopulmonary disease that is unresponsive to conventional therapy. Vital to its success is the insertion and maint enance of appropriately sized vascular cannulas. Problematic insertion and accidental dislodgments can be life threatening. To determine the treatment and outcome of these complications, a survey of participati ng Extracorporeal Life Support Organization centers was undertaken. Ve nous cannulation complications (13 patients) were due to inadequate ve in size or tearing during initial attempts at cannulation. Proximal an d alternative site cannulation were used. Difficult arterial cannulati ons (seven patients) were most often due to creation of an intimal fla p that was corrected by proximal cannulation of the same vessel. The 1 0 cases of accidental dislodgment were most often associated with chan ges in position. Despite copious hemorrhage in many instances, 6 of 10 patients survived with intact neurologic status. Methods for dealing with these life threatening cannula related complications are describe d.