Central Line Placement at ECMO Decannulation: A Missed Opportunity
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Read the article on jpedsurg.org ↗Article · Feb 2021 · 1 min read
In brief
In brief
Retrospective study of 65 pediatric ECMO patients shows only 31% received central venous lines at decannulation, yet 40% of those without lines required one within 30 days. Lines placed at decannulation had high functionality (85%) with no infectious complications, suggesting decannulation presents an underutilized opportunity for safe central access placement in patients likely to need ongoing support.
Written by the GCMD Library team from the article.
Abstract
Introduction
ECMO is a support modality for refractory critical illness. This study reviews the incidence and utility of central venous line (CVL) placement at pediatric ECMO decannulation.
Methods
A single-institution retrospective study of patients undergoing open neck decannulation from 2015 to 2019. Patients were divided into two groups: ≤ 28-days and > 28-days.
Results
Of 65 patients, 31% had a CVL placed at decannulation. Sepsis and pneumonia were the most common indications for ECMO in the older-group compared to CDH in neonates. The most common indications for CVL were hemodialysis (45%), monitoring (25%), and access (25%). 89% of neonates had an access line placed, whereas 73% of the older group received hemodialysis catheters. Median CRRT requirement was 20 days. 85% of lines were functional at time of removal or death. None were removed for infection. 40% of the patients not receiving a CVL at decannulation required one within 30 days.
Conclusion
69% of patients did not have a CVL placed at decannulation, however 40% required a CVL within 30 days. Most lines placed at decannulation remained functional and none were removed for infection. Decannulation removes the circuit as a route for vascular access, but it also presents an opportunity to safely place an essential CVL.