POINT-OF-CARE ULTRASOUND-GUIDED PERCUTANEOUS CANNULATION OF EXTRACORPOREAL MEMBRANE OXYGENATION: MAKE IT SIMPLE

被引:22
作者
Ahn, Hong Joon [1 ]
Lee, Jun Wan [2 ]
Joo, Ki Hyuk [3 ]
You, Yeon Ho [3 ]
Ryu, Seung [3 ]
Lee, Jin Woong [3 ]
Kim, Seung Whan [3 ]
机构
[1] Chungnam Natl Univ Hosp, Surg Intens Care Unit, Daejeon, South Korea
[2] Chungnam Natl Univ Hosp, Reg Emergency Ctr, Emergency Intens Care Unit, 282 Munwha Ro, Daejeon 30172, South Korea
[3] Chungnam Natl Univ Hosp, Dept Emergency Med, Daejeon, South Korea
关键词
extracorporeal membrane oxygenation; cannulation; ultrasonography; fluoroscopy; transthoracic echocardiography; transesophageal echocardiography; REFRACTORY CARDIAC-ARREST; LIFE-SUPPORT; CARDIOPULMONARY-RESUSCITATION; RESPIRATORY-FAILURE; ECHOCARDIOGRAPHY; ECMO; ADULTS; TRANSPORT;
D O I
10.1016/j.jemermed.2017.12.013
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Cannulation of the great vessels is required for extracorporeal membrane oxygenation (ECMO). Currently, there is no guideline for optimal imaging modalities during percutaneous cannulation of ECMO. Objective: The purpose of this study was to describe percutaneous cannulation guided by point-of-care ultrasound (POCUS) for ECMO and compare it with fluoroscopy and landmark guidance. Methods: Three groups (POCUS-, fluoroscopy-, and landmark-guided) of percutaneous cannulation for ECMO were analyzed retrospectively in a tertiary academic hospital. In the POCUS-guided group, visual confirmation of guidewire and cannula by ultrasound in both the access and return cannula were essential for successful cannulation. Fluoroscopy- and landmark-guided groups were cannulated with the conventional technique. Results: A total of 128 patients were treated by ECMO during the study period, of which 94 (73.4%) cases were venoarterial ECMO. This included 56 cases of extracorporeal cardiopulmonary resuscitation. Also, there were 30 (23.4%) cases of venovenous ECMO and 4 (3.1 %) cases of venoarter-iovenous ECMO. A total of 71 (55.5 %) patients were cannulated under POCUS guidance, and 43 (33.6 %) patients were cannulated under fluoroscopy guidance and 14 (10.9 %) patients were cannulated by landmark guidance. No surgical cut downs were required. Misplacement of cannula occurred in 3 (2.3%) cases. All three occurred in the landmark-guided group. Conclusions: POCUS-guided cannulation is comparable to fluoroscopy-guided cannulation in terms of avoiding cannula misplacement. In our experience, POCUS-guided cannulation is a useful strategy over fluoroscopy- and landmark-guided cannulation during periphereal ECMO. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:507 / 513
页数:7
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