Comparing percutaneous to open access for extracorporeal membrane oxygenation in pediatric respiratory failure

American Pediatric Surgical Association Critical Care Committee

Research output: Contribution to journalArticle

Abstract

Objectives: Evaluate trends in method of access (percutaneous cannulation vs open cannulation) for pediatric extracorporeal membrane oxygenation and determine the effects of cannulation method on morbidity and mortality. Design: Retrospective cohort study. Setting and Subjects: The Extracorporeal Life Support Organization's registry was queried for pediatric patients on extracorporeal membrane oxygenation for respiratory failure from 2007 to 2015. Inverventions: None. Measurements and Main Results: Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to 70% (p < 0.001). Percutaneous cannulation patients were more commonly male (24.2% vs 21.5%; p = 0.01), older (average 7.6 vs 4.5 yr; p < 0.001), and heavier (average 33.0 vs 20.2 kg; p < 0.001). Subset analysis of patients on venovenous extracorporeal membrane oxygenation revealed higher rates of mechanical complications due to blood clots (28.9% vs 22.6%; p = 0.003) or cannula problems (18.9% vs 12.7%; p < 0.001), cannula site bleeding (25.3% vs 20.2%; p = 0.01) and increased rates of cannula site repair in the open cannulation cohort. Limb related complications were not significantly different on subset analysis for venovenous extracorporeal membrane oxygenation patients stratified by access site. Logistic regression analysis revealed that method of access was not associated with a difference in mortality. Conclusions: The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique.

Original languageEnglish (US)
Pages (from-to)981-991
Number of pages11
JournalPediatric Critical Care Medicine
Volume19
Issue number10
DOIs
StatePublished - Jan 1 2018

Fingerprint

Extracorporeal Membrane Oxygenation
Catheterization
Respiratory Insufficiency
Pediatrics
Mortality
Registries
Thrombosis
Cohort Studies
Extremities
Retrospective Studies
Logistic Models
Regression Analysis
Organizations
Hemorrhage
Morbidity

Keywords

  • Extracorporeal life support
  • Extracorporeal membrane oxygenation
  • Pediatric critical care
  • Pediatric surgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Comparing percutaneous to open access for extracorporeal membrane oxygenation in pediatric respiratory failure. / American Pediatric Surgical Association Critical Care Committee.

In: Pediatric Critical Care Medicine, Vol. 19, No. 10, 01.01.2018, p. 981-991.

Research output: Contribution to journalArticle

American Pediatric Surgical Association Critical Care Committee. / Comparing percutaneous to open access for extracorporeal membrane oxygenation in pediatric respiratory failure. In: Pediatric Critical Care Medicine. 2018 ; Vol. 19, No. 10. pp. 981-991.
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abstract = "Objectives: Evaluate trends in method of access (percutaneous cannulation vs open cannulation) for pediatric extracorporeal membrane oxygenation and determine the effects of cannulation method on morbidity and mortality. Design: Retrospective cohort study. Setting and Subjects: The Extracorporeal Life Support Organization's registry was queried for pediatric patients on extracorporeal membrane oxygenation for respiratory failure from 2007 to 2015. Inverventions: None. Measurements and Main Results: Of 3,501 patients identified, 77.2{\%} underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80{\%} to 70{\%} (p < 0.001). Percutaneous cannulation patients were more commonly male (24.2{\%} vs 21.5{\%}; p = 0.01), older (average 7.6 vs 4.5 yr; p < 0.001), and heavier (average 33.0 vs 20.2 kg; p < 0.001). Subset analysis of patients on venovenous extracorporeal membrane oxygenation revealed higher rates of mechanical complications due to blood clots (28.9{\%} vs 22.6{\%}; p = 0.003) or cannula problems (18.9{\%} vs 12.7{\%}; p < 0.001), cannula site bleeding (25.3{\%} vs 20.2{\%}; p = 0.01) and increased rates of cannula site repair in the open cannulation cohort. Limb related complications were not significantly different on subset analysis for venovenous extracorporeal membrane oxygenation patients stratified by access site. Logistic regression analysis revealed that method of access was not associated with a difference in mortality. Conclusions: The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique.",
keywords = "Extracorporeal life support, Extracorporeal membrane oxygenation, Pediatric critical care, Pediatric surgery",
author = "{American Pediatric Surgical Association Critical Care Committee} and Cairo, {Sarah B.} and Mary Arbuthnot and Laura Boomer and Dingeldein, {Michael W.} and Alexander Feliz and Samir Gadepalli and Newton, {Christopher R.} and Pramod Puligandla and Robert Ricca and Peter Rycus and Vogel, {Adam M.} and Guan Yu and Ziqiang Chen and Rothstein, {David H.} and Abdessalam, {Shahab D.} and Acton, {Robert D.} and Pablo Aguayo and Aldrink, {Jennifer H.} and Arnold, {Meghan A.} and Hirschl, {Ronald B.} and {Craig Egan}, J. and Alejandro Garcia and Klinkner, {Denise B.} and Laituri, {Carrie A.} and Rice-Townsend, {Samuel E.} and Ana Ruzic and Siddiqui, {Sabina M.}",
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AU - American Pediatric Surgical Association Critical Care Committee

AU - Cairo, Sarah B.

AU - Arbuthnot, Mary

AU - Boomer, Laura

AU - Dingeldein, Michael W.

AU - Feliz, Alexander

AU - Gadepalli, Samir

AU - Newton, Christopher R.

AU - Puligandla, Pramod

AU - Ricca, Robert

AU - Rycus, Peter

AU - Vogel, Adam M.

AU - Yu, Guan

AU - Chen, Ziqiang

AU - Rothstein, David H.

AU - Abdessalam, Shahab D.

AU - Acton, Robert D.

AU - Aguayo, Pablo

AU - Aldrink, Jennifer H.

AU - Arnold, Meghan A.

AU - Hirschl, Ronald B.

AU - Craig Egan, J.

AU - Garcia, Alejandro

AU - Klinkner, Denise B.

AU - Laituri, Carrie A.

AU - Rice-Townsend, Samuel E.

AU - Ruzic, Ana

AU - Siddiqui, Sabina M.

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N2 - Objectives: Evaluate trends in method of access (percutaneous cannulation vs open cannulation) for pediatric extracorporeal membrane oxygenation and determine the effects of cannulation method on morbidity and mortality. Design: Retrospective cohort study. Setting and Subjects: The Extracorporeal Life Support Organization's registry was queried for pediatric patients on extracorporeal membrane oxygenation for respiratory failure from 2007 to 2015. Inverventions: None. Measurements and Main Results: Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to 70% (p < 0.001). Percutaneous cannulation patients were more commonly male (24.2% vs 21.5%; p = 0.01), older (average 7.6 vs 4.5 yr; p < 0.001), and heavier (average 33.0 vs 20.2 kg; p < 0.001). Subset analysis of patients on venovenous extracorporeal membrane oxygenation revealed higher rates of mechanical complications due to blood clots (28.9% vs 22.6%; p = 0.003) or cannula problems (18.9% vs 12.7%; p < 0.001), cannula site bleeding (25.3% vs 20.2%; p = 0.01) and increased rates of cannula site repair in the open cannulation cohort. Limb related complications were not significantly different on subset analysis for venovenous extracorporeal membrane oxygenation patients stratified by access site. Logistic regression analysis revealed that method of access was not associated with a difference in mortality. Conclusions: The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique.

AB - Objectives: Evaluate trends in method of access (percutaneous cannulation vs open cannulation) for pediatric extracorporeal membrane oxygenation and determine the effects of cannulation method on morbidity and mortality. Design: Retrospective cohort study. Setting and Subjects: The Extracorporeal Life Support Organization's registry was queried for pediatric patients on extracorporeal membrane oxygenation for respiratory failure from 2007 to 2015. Inverventions: None. Measurements and Main Results: Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to 70% (p < 0.001). Percutaneous cannulation patients were more commonly male (24.2% vs 21.5%; p = 0.01), older (average 7.6 vs 4.5 yr; p < 0.001), and heavier (average 33.0 vs 20.2 kg; p < 0.001). Subset analysis of patients on venovenous extracorporeal membrane oxygenation revealed higher rates of mechanical complications due to blood clots (28.9% vs 22.6%; p = 0.003) or cannula problems (18.9% vs 12.7%; p < 0.001), cannula site bleeding (25.3% vs 20.2%; p = 0.01) and increased rates of cannula site repair in the open cannulation cohort. Limb related complications were not significantly different on subset analysis for venovenous extracorporeal membrane oxygenation patients stratified by access site. Logistic regression analysis revealed that method of access was not associated with a difference in mortality. Conclusions: The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique.

KW - Extracorporeal life support

KW - Extracorporeal membrane oxygenation

KW - Pediatric critical care

KW - Pediatric surgery

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