Safety of Delayed Decannulation of Venoarterial Cannulas in Patients with Congenital Diaphragmatic Hernia
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Oct 2019 · 1 min read
In brief
In brief
Retrospective study of 19 CDH patients demonstrates that delayed decannulation after venoarterial ECLS—leaving heparinized cannulas in place for median 26 hours—is safe with minimal complications. Only one patient (5%) required re-initiation during observation period, with no major bleeding or embolic events, supporting this strategy for high-risk patients.
Written by the GCMD Library team from the article.
Background
The practice of "cutting-away" from venoarterial extracorporeal life support (ECLS) and leaving indwelling heparinized cannulas prior to decannulation is controversial. This study aims to determine the safety and efficacy of this strategy in patients with congenital diaphragmatic hernia (CDH) who require ECLS.
Methods
A single-center retrospective review of electronic health records was performed on all patients with CDH who underwent elective ECLS decannulation between January 2014 and September 2018. Descriptive statistics are presented as medians with interquartile range.
Results
Seventy-three percent (19/26) of patients who underwent venoarterial ECLS for CDH were electively decannulated. After a median ECLS run of 10.7 days [6.1–19.5], patients were "cut-away" for a median of 26 h [19.8–43] prior to decannulation. One patient required re-initiation at 36 h for a pulmonary hypertensive crisis (5%). There were no major bleeding or embolic events while "cut-away", and four (21%) patients had clots removed from the cannulas without clinical sequelae. One patient was recannulated 16 days following initial decannulation.
Conclusions
Our data suggests that "cutting-away" from ECLS in patients with congenital diaphragmatic hernia is safe and allows a period of observation without significant complications. This strategy may be particularly helpful in patients at risk for recannulation, but better prognostic criteria are needed.
Level of Evidence
Level IV.
Type of Study
Treatment Study.