CERVICAL ECMO CANNULA PLACEMENT IN INFANTS AND CHILDREN - RECOMMENDATIONS FOR ASSESSMENT OF ADEQUATE POSITIONING AND FUNCTION

Background/Purpose: Cervical extracorporeal membrane oxygenation (ECMO ) cannula position is often difficult to confirm by chest x-ray alone. Malposition requires a second surgery to rectify the problem. Reopera tion places the patient at risk for infection, bleeding, or death. Thi s study analyzes indications for cannula repositioning and suggests an alternative standard for intraoperative evaluation of catheter functi on as it relates to position. Methods: The authors reviewed charts of 73 patients placed on arterio-venous ECMO through cervical vascular ac cess. Reasons for repositioning of either cannula at the initial surge ry or postoperatively were recorded. Results: Of 73 patients, 18 (24.6 %) required either arterial cannula or venous cannula repositioning. I n 10 (55%) of these patients, cannula malposition was not detected by chest x-ray during the initial cannulation, and they therefore require d a second cervical exploration for repositioning. Conclusions: Chest x-ray is not sensitive in demonstrating malpositioned cervical ECMO ca nnulae. Two-dimensional ECHO before wound closure, may be a superior, more cost effective means of assessing cannula placement and function than x-ray alone. Confirmation of cannula position and function, befor e wound closure, would reduce the risks involved with cervical reexplo ration. J Pediatr Surg 33:929-937. Copyright (C) 1998 by W.B. Saunders Company.