Point-of-Care Ultrasound-Guided Percutaneous Cannulation of Extracorporeal Membrane Oxygenation: Make it Simple.
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 venoarteriovenous 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 peripheral ECMO.
['Ahn|Hong Joon|HJ|', 'Lee|Jun Wan|JW|', 'Joo|Ki Hyuk|KH|', 'You|Yeon Ho|YH|', 'Ryu|Seung|S|', 'Lee|Jin Woong|JW|', 'Kim|Seung Whan|SW|']
D000328:Adult D000368:Aged D002404:Catheterization D015331:Cohort Studies D015199:Extracorporeal Membrane Oxygenation D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D019095:Point-of-Care Systems D011446:Prospective Studies D012189:Retrospective Studies D014463:Ultrasonography
cannulation extracorporeal membrane oxygenation fluoroscopy transesophageal echocardiography transthoracic echocardiography ultrasonography