TY - JOUR
T1 - Weaning from neonatal and pediatric ECMO with stand-by cannula
AU - Bobillo-Perez, Sara
AU - Cuaresma, Adriana
AU - Girona-Alarcon, Monica
AU - Sole-Ribalta, Anna
AU - Cañizo, Debora
AU - Cambra, Francisco Jose
AU - Jordan, Iolanda
AU - Segura, Susana
AU - Pertierra, Africa
N1 - Funding Information:
Special thanks to the ECMO team of the Hospital Sant Joan de Déu, including surgeons, nurses, and physicians.
Publisher Copyright:
© 2021, The Japanese Society for Artificial Organs.
PY - 2021/12
Y1 - 2021/12
N2 - The precise moment for weaning a patient off extracorporeal membrane oxygenation (ECMO) is not always easy to establish. Also, mechanical causes may obligate to disconnect the patient from the circuit before the optimal weaning off. In these selected cases, the patient can be disconnected from the circuit and the cannula can be left in place (stand-by cannula) until the patient’s stability without ECMO is assured. The aim was to describe our experience with the stand-by cannula. Single-institution, long-term retrospective study in a pediatric tertiary care hospital. Neonatal and pediatric patients who were under ECMO and needed stand-by cannula before definitive de-cannulation were included. During 18 years, 166 children required ECMO. In 31 patients (18.7%), stand-by cannula was performed before the weaning off. Twenty patients (64.5%) were newborn. The main reason for requiring ECMO in these newborn was persistent pulmonary hypertension. Eleven patients were pediatric and their main cause for requiring ECMO was cardiogenic shock (six patients, 54.4%). The reasons for requiring stand-by cannula were the uncertainty of a successful weaning off in 17 patients (54.8%), to undergo surgery in 10 patients (32.3%) and to replace the circuit in four cases (12.9%). The median duration of stand-by cannula was 12 h (IQR 6–24). Heparinized saline serum was the main maintenance perfusion (28 patients, 90.3%). Three patients needed to restart support with ECMO. Only one mechanical complication was detected. Stand-by cannula is a safe technique, which allows performing a quick re-entrance on ECMO if the weaning off fails.
AB - The precise moment for weaning a patient off extracorporeal membrane oxygenation (ECMO) is not always easy to establish. Also, mechanical causes may obligate to disconnect the patient from the circuit before the optimal weaning off. In these selected cases, the patient can be disconnected from the circuit and the cannula can be left in place (stand-by cannula) until the patient’s stability without ECMO is assured. The aim was to describe our experience with the stand-by cannula. Single-institution, long-term retrospective study in a pediatric tertiary care hospital. Neonatal and pediatric patients who were under ECMO and needed stand-by cannula before definitive de-cannulation were included. During 18 years, 166 children required ECMO. In 31 patients (18.7%), stand-by cannula was performed before the weaning off. Twenty patients (64.5%) were newborn. The main reason for requiring ECMO in these newborn was persistent pulmonary hypertension. Eleven patients were pediatric and their main cause for requiring ECMO was cardiogenic shock (six patients, 54.4%). The reasons for requiring stand-by cannula were the uncertainty of a successful weaning off in 17 patients (54.8%), to undergo surgery in 10 patients (32.3%) and to replace the circuit in four cases (12.9%). The median duration of stand-by cannula was 12 h (IQR 6–24). Heparinized saline serum was the main maintenance perfusion (28 patients, 90.3%). Three patients needed to restart support with ECMO. Only one mechanical complication was detected. Stand-by cannula is a safe technique, which allows performing a quick re-entrance on ECMO if the weaning off fails.
KW - Cannula
KW - Extracorporeal circulation
KW - Extracorporeal membrane oxygenation
KW - Oxygenators
KW - Weaning
UR - http://www.scopus.com/inward/record.url?scp=85101004369&partnerID=8YFLogxK
U2 - 10.1007/s10047-021-01251-x
DO - 10.1007/s10047-021-01251-x
M3 - Article
C2 - 33580434
AN - SCOPUS:85101004369
SN - 1434-7229
VL - 24
SP - 507
EP - 510
JO - Journal of Artificial Organs
JF - Journal of Artificial Organs
IS - 4
ER -