Survey of the American Pediatric Surgical Association on cannulation practices in pediatric ECMO

Infographic · Oct 2018 · 1 min read

In brief

APSA survey of 252 members reveals significant practice variation in pediatric ECMO cannulation, with 28% using neck vessels exclusively and divergent approaches to carotid repair and femoral access timing. Less experienced surgeons more frequently consult vascular surgery, highlighting need for standardized training and evidence-based guidelines.

28% of pediatric surgeons use neck vessels exclusively for ECMO cannulation regardless of patient age or weight.
Only 6.6% routinely repair carotid artery after neck decannulation; 10.7% repair selectively in children over 5 years.
Distal perfusion management is the most common challenge (60%) when performing femoral ECMO cannulation in children.
Surgeons with <10 years experience are twice as likely to consult vascular surgery for femoral cannulation (18.5% vs 8%).
No consensus exists on age/weight thresholds for femoral cannulation; practices range from 5 years to 12 years minimum.

Written by the GCMD Library team from the infographic.

The infographic uses a three-column layout with green panels on a light blue background. The left panel shows a colorful icon of people around a medical cross representing team collaboration. The center panel displays a line drawing of a child in prone position. The right panel features an anatomical diagram of a child's body with red circles highlighting neck and femoral cannulation sites, with percentages labeled.

Aims

Extracorporeal membrane oxygenation (ECMO) is a commonly used modality of life support for children with cardiopulmonary failure. Consensus on pediatric cannulation strategies and management does not currently exist. The goal of this study was to investigate individual surgeon approaches towards ECMO cannulations in children.

Methods

A 21-question online survey was developed and disseminated to the American Pediatric Surgical Association (APSA) membership. Participant responses were summarized as counts and percentages. Effect of ECMO volume and surgeon experience on responses was assessed.

Results

There were 252 APSA members who participated in this study for a response rate of 21%, with 225 (89.3%) performing ECMO. Sixty respondents (28.3%) reported using neck vessels exclusively for cannulation regardless of age or weight of the patient. After neck decannulation, 13 (6.6%) repaired the carotid artery for all patients, and 21 (10.7%) repaired only for children older than 5 years. Of those performing femoral cannulation, 56 (26.4%) would perform at 5 years or older and 66 (31.1%) at 12 years. The most common challenge for femoral cannulation was the need for distal perfusion (n = 119; 59.8%). Assistance from vascular surgery was requested by 32 (16.4%) for distal perfusion catheter placement, and by 79 (40.5%) for decannulation. Regarding femoral cannulation, lack of training was more likely to be a challenge if performing <5 cannulations per year (25.2% vs 12.5%; p = 0.03). Surgeons with <10 years of experience were more likely to consult vascular surgery compared to those with >10 years of experience (18.5% vs 8%; p = 0.03).

Conclusion

Considerable variation exists in individual surgeon cannulation practices in pediatric ECMO, in particular in the management of school age and adolescent VA ECMO. Mixed approaches across several ECMO management case study questions indicate that further work is needed to evaluate specific risks with cannulations in children.