Point-of-Care Ultrasound-Guided Percutaneous Cannulation of Extracorporeal Membrane Oxygenation: Make it Simple

J Emerg Med. 2018 Apr;54(4):507-513. doi: 10.1016/j.jemermed.2017.12.013. Epub 2017 Dec 30.

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.

Keywords: cannulation; extracorporeal membrane oxygenation; fluoroscopy; transesophageal echocardiography; transthoracic echocardiography; ultrasonography.

MeSH terms

  • Adult
  • Aged
  • Catheterization / instrumentation
  • Catheterization / methods*
  • Catheterization / standards
  • Cohort Studies
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Point-of-Care Systems / standards
  • Prospective Studies
  • Retrospective Studies
  • Ultrasonography / methods
  • Ultrasonography / standards*
  • Ultrasonography / trends