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

Research output: Contribution to journalArticle

Abstract

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. Level of evidence: IV.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Extracorporeal Membrane Oxygenation
Catheterization
Pediatrics
Thigh
Neck
Organizational Case Studies
Perfusion
Surveys and Questionnaires
Carotid Arteries
Blood Vessels
Catheters
Weights and Measures

Keywords

  • ECMO
  • Femoral cannulation
  • Survey

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

@article{511106d4d67a4554aa65f13fd13a509b,
title = "Survey of the American Pediatric Surgical Association on cannulation practices in pediatric ECMO",
abstract = "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. Level of evidence: IV.",
keywords = "ECMO, Femoral cannulation, Survey",
author = "Alejandro Garcia and Maniraj Jeyaraju and Ladd, {Mitchell R.} and Eric Jelin and Melania Bembea and Alaish, {Samuel M.} and Daniel Rhee",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.jpedsurg.2017.11.046",
language = "English (US)",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Survey of the American Pediatric Surgical Association on cannulation practices in pediatric ECMO

AU - Garcia, Alejandro

AU - Jeyaraju, Maniraj

AU - Ladd, Mitchell R.

AU - Jelin, Eric

AU - Bembea, Melania

AU - Alaish, Samuel M.

AU - Rhee, Daniel

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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. Level of evidence: IV.

AB - 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. Level of evidence: IV.

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