Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients with Right Cervical Cannulation: A 15-Year Single-Center Experience

Objectives: Extracorporeal membrane oxygenation (ECMO) despite its common use in cases of severe cardiopulmonary failure in adult and pediatric patients still remains a challenge in modern intensive medicine. In this study, we analyzed our experience with ECMO support through cervical cannulation in infants and pediatric patients.

Methods: From January 2003 to August 2018, a total of 186 pediatric patients (< 18 years old) were supported with ECMO in our institution. In this study, we included the 64 neonates and pediatric patients with cervical venoarterial ECMO cannulation.

Results: The median patient age and body weight were 2 days (range: 0 days–3.6 years) and 3.5 kg (range: 1.7–14 kg). All patients were cannulated through right internal jugular vein and right common carotid artery (8–14 Fr for vein and 8–10 Fr for artery). Seven patients were put on ECMO in other hospital by mobile ECMO team and transported to our pediatric intensive care unit. Congenital diaphragmatic hernia was the most common diagnosis—43% (n = 28), followed by uncorrected congenital heart disease—14% (n = 9), meconium aspiration syndrome (MAS)—11% (n = 7), cardiomyopathy—8% (n = 5), myocarditis—6% (n = 4), sepsis and/or pneumonia—6% (n = 4), pulmonary hypertension—4% (n = 3), and others—6% (n = 4). The median duration of support was 8 days (range: 2–94 days). In six cases, the ECMO was used in extubated, spontaneously breathing children (“awake ECMO”). ECMO was weaned/discontinued in 79% of patients (51 of 64). Four patients were bridged to ventricle assist device, one patient was successfully bridged to heart transplantation and one patient to lung transplantation. The overall survival was 75% (48 of 64), the survival rate for respiratory support was 89% (37 of 42) in with MAS had a superior outcome (100% survival). In the cardiac support group, survival rate was 66.5% (12 of 18). All transported patients (n = 7) survived and were discharged or transferred to home hospitals, respectively. Abnormal cerebral ultrasound or CT/MRI findings during or post-ECMO were found in 11% of patients (7 of 64) with residues in three patients.

Conclusion: ECMO is an effective support form for refractory severe cardiopulmonary failure with excellent outcome in some groups (MAS or pneumonia). The cervical cannulation is a safe und valuable technique of peripheral venoarterial ECMO cannulation and could be a useful transportation tool for neonates and pediatric patients under 15 kg.