Pediatric arterial femoral cannulations for extracorporeal membrane oxygenation: Does size really matter?

Alejandro V Garcia; Eric W Etchill; Melania M Bembea; Brian W Gray; Daniel S Rhee

doi:10.1016/j.jpedsurg.2021.01.044

Pediatric arterial femoral cannulations for extracorporeal membrane oxygenation: Does size really matter?

J Pediatr Surg. 2021 Sep;56(9):1643-1646. doi: 10.1016/j.jpedsurg.2021.01.044. Epub 2021 Feb 4.

Authors

Alejandro V Garcia¹, Eric W Etchill², Melania M Bembea³, Brian W Gray⁴, Daniel S Rhee²

Affiliations

¹ Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA. Electronic address: agarci41@jhmi.edu.
² Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
³ Department of Anesthesia and Critical Care, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
⁴ Department of Surgery, Indiana University, Bloomington, IN 47405, USA.

PMID: 33583565
DOI: 10.1016/j.jpedsurg.2021.01.044

Abstract

Background: No studies exist comparing various femoral artery cannula sizes in children on ECMO. We hypothesize that smaller arterial cannulas provide adequate flow in children while decreasing vascular complications.

Methods: We performed a retrospective review of the ELSO database from 2012-2017. We included children undergoing femoral venoarterial ECMO between ages 12 and 18 years and weighing more than 30 kg. Arterial cannula sizes were grouped as: 15-16Fr, 17-18Fr, 19-20Fr and ≥21Fr. Arterial pump flow, bleeding complications, limb ischemia, and mechanical complications were compared by cannula size. Distal perfusion catheter and percutaneous placement were also compared for complications.

Results: A total of 429 patients were included with 28.2% 15-16Fr, 32.2% 17-18Fr, 22.8% 19-20Fr, and 16.8% ≥ 21Fr arterial femoral cannulas. Median age was lower in the 15-16Fr group compared to the largest cannula group (14.7 years vs 15.5 years, p < 0.01). The overall mean arterial flow was 57.4 +/- 17.0 mL/kg/min with no difference in mean arterial flow rates among the cannula size groups (p = 0.85). There were no significant differences in all complications, bleeding or mechanical complications by arterial cannula size group. However, there was an increased risk of limb ischemia in the ≥21Fr group compared to the 15-16Fr group (OR 4.38, 95% CI 1.24-15.43; p = 0.02). Distal perfusion catheter was shown to increase the risk of mechanical complications (OR 1.78; 95% CI 1.03-3.07; p = 0.04) but did not make a statistically significant difference in limb ischemia (OR 0.37; 95% CI 0.12-1.11; p = 0.07).

Conclusion: Review of the ELSO database demonstrates that the use of larger arterial cannulas compared to 15-16Fr cannulas are not needed to achieve similar pump flows for hemodynamic support but the largest cannula sizes may increase the risk of ischemic complications.

Keywords: Cannulation; Cardiopulmonary failure; Extracorporeal membrane oxygenation (ECMO); Level of evidence: Level III; Venoarterial ECMO.

MeSH terms

Adolescent
Catheterization, Peripheral* / adverse effects
Child
Extracorporeal Membrane Oxygenation* / adverse effects
Femoral Artery
Humans
Retrospective Studies
Risk Factors