Best Practices for Vessel Management in Pediatric Extracorporeal Membrane Oxygenation Cannulation, Decannulation, and Follow-up: A Narrative Review

jpedsurg.org

Extracorporeal membrane oxygenation (ECMO) to support neonates and children with cardiopulmonary failure was first described in the 1970s, since which time its use has expanded to an increasingly complex and heterogenous pediatric population. Despite preserved survival outcomes, complications of ECMO use, including iatrogenic vascular injury, are common. Here, we provide a brief overview of the epidemiology of pediatric ECMO and associated vascular complications; describe common peripheral cannulation equipment and techniques, trends in cannulation and decannulation strategies, and respective incidence of vascular complications; and review existing evidence for best practices in cannula site selection, cannulation technique, decannulation strategies, and management of vascular complications, with the goal of providing a comprehensive review for interventionalists involved in the care of pediatric ECMO patients.

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Article · Sep 2024 · 1 min read

In brief

This narrative review examines best practices for vascular access management throughout the ECMO lifecycle in pediatric patients, from initial cannulation through decannulation and follow-up care. The authors synthesize evidence on cannula site selection, insertion techniques, and complication prevention strategies to guide interventionalists managing iatrogenic vascular injuries in this complex patient population.

Vascular complications are common in pediatric ECMO despite preserved survival, requiring careful vessel management strategies.
Cannula site selection and technique significantly impact iatrogenic vascular injury rates in neonatal and pediatric ECMO patients.
Decannulation strategy choice affects long-term vascular outcomes and should be evidence-based for each patient population.
Interventionalists need standardized approaches to prevent and manage ECMO-related vascular complications in children.
Pediatric ECMO population complexity has increased since the 1970s, necessitating updated vessel management protocols.

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