Cannula Position Confirmation before Transportation of Veno-Venous ECMO Patients is Not Necessary: A Mobile ECMO Program Experience

• Published in: The Journal of heart and lung transplantation Vol. 40; no. 4; p. S404
• Main Authors: Jaiswal, A., Gadela, N., Kurtzman, E., Drake, C., Underhill, D., Gluck, J.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2021
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2021.01.1135

Mobile ECMO program supports patients with refractory acute respiratory failure deemed at high risk for transfer to an ECMO center. Transesophageal or transthoracic echocardiography and/or radiographic imaging is routinely done to confirm cannula position before departure to the receiving center. We herein report the feasibility and outcomes of the first case-series with transportation of VV-ECMO patients without confirmatory imaging.
Adult patients who underwent mobile VV-ECMO implantation.
71 adult VV-ECMO recipients were included, all with dual cannula implant schema: 14 (19.7%) transferred without confirmation; median (inter-quartile range) age was 51 (18, 80) years, BMI was 33.05 (21.7, 62.8) and 43.7% were female. Baseline characteristics of patients were similar in groups with and without cannula confirmation (Table). No complications occurred during cannulation or transportation. Two cannula malpositions were identified: 1) imaging group - venous inflow was noted to course from right femoral vein to the left without flow issues and was changed at the sending center; 2) non-imaging group a “kink” in IVC cannula was noted after arrival without flow issues.
With the use of point of care ultrasound, line placement safety is drastically improved, and transportation of patients with ARDS on VV ECMO with a stable flow is feasible without cannula position confirmation. This approach can decrease resource utilization, healthcare cost and minimize out-of facility time for the implant team.