From
Dr. Nelson G. Rosen
ECMO cannulation site selection in pediatric ECPR: neck versus femoral approach
With Dr. Juan Guerrilla & Dr. David Rothstein · hosted by Lizzy Lee, PA-C
Chapter 1 of 4
Regional practices
Introduction and regional practice variation
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
In Seattle, femoral cannulation is preferred because it stays out of the way of CPR
Femoral cannulation works better in bigger kids due to vessel size
Femoral cannulation carries risk of femoral vessel injury and limb loss
One institution does neck cannulation almost exclusively
Stroke rate with neck cannulation is up to 10% on current data
There is debate over ligation versus reconstruction with pros and cons to both approaches
At Seattle Children's, narrowing of different percentages has been found even with ligation, including intimal flaps
Long-term vascular surveillance is recommended rather than a one-time assessment
There is no universally superior cannulation approach for pediatric ECPR
The optimal cannulation site depends on the patient's size, anatomy, clinical condition, and the expertise of the ECMO team
Femoral cannulation can make ongoing resuscitation easier, particularly in adolescents
With femoral cannulation, it is important to protect limb perfusion and maintain blood flow to the leg
In younger children, neck cannulation often provides better vessel size and more reliable flow
Neck cannulation carries concern about neurologic complications, although newer evidence suggests the stroke risk may be lower than previously believed
Neither femoral nor neck cannulation approach is risk-free
After decannulation from ECMO, the vessel can either be ligated (permanently tied off) or reconstructed (surgically repaired)
54% in the carotid group have significant vascular changes such as occlusion, stenosis, and intimal changes
The literature does not support a single best cannulation site for every patient
Key considerations for cannulation site selection include patient size, anatomy, clinical condition, and risk
The femoral approach has easier access but requires monitoring of limb perfusion
The neck approach is better in smaller children but requires consideration of neurologic risk
Success is consistently predicted by having an experienced team that can establish ECMO rapidly and safely using the technique they know best