J Pediatr Surg
. 2026 Jun 25;61(9):163259.
doi: 10.1016/j.jpedsurg.2026.163259. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/42349545/
ECMO cannulation techniques in children: Heterogeneous and often complicated
Lucas Moratilla-Lapeña 1, María Del Carmen Sarmiento 2, Alejandro Madurga 2, María Lopez-Canelada 2, Juvenal Rey 3, Iñigo Velasco 4, Carlos De La Torre 2, Paula Burgos 4, Jose Luis Encinas 2, Francisco Hernandez-Oliveros 5
Affiliations Expand
- PMID: 42349545
- DOI: 10.1016/j.jpedsurg.2026.163259
Abstract
Introduction: Indications for ECMO are increasing, but standardized cannulation guidelines are lacking. This study aimed to describe complications and variability in management.
Methods: A single-center retrospective review of children undergoing cervical ECMO (2016-2023). Data included demographics, ECMO technique, cannula size, complications (ELSO classification), mortality and follow-up. Surgeon specialty [pediatric (PS) or cardiothoracic (CS)] and cannula fixation method (ligation vs. non-ligation) were recorded.
Results: Twenty-seven patients underwent ECMO, mainly for congenital diaphragmatic hernia (37%). All CS used non-ligation fixation (8/27), while PS used ligation fixation (19/27). Complications occurred in 74% of patients, predominantly mechanical (52%). PS cases had more cannula malposition and surgical site bleeding. Bleeding requiring intervention occurred in two patients per group. All patients with a 6 Fr arterial cannula died from hemolysis or pump failure. At decannulation, CS repaired both vessels, whereas PS repaired the artery and ligated the vein, with heterogeneous anticoagulation strategies. Six-month follow-up ultrasound was available in 10 of 13 patients who underwent arterial repair, showing patency rates of 5/5 (100%) for repaired arteries in the non-ligation group, and 4/5 (80%) in the ligation group. Venous patency was confirmed in 2/5 (40%) of repaired veins.
Conclusion: Cervical ECMO cannulation carries high complication rates and heterogeneous management. All patients cannulated with a 6 Fr arterial cannula died, suggesting that an 8 Fr cannula should be used whenever technically feasible and that central ECMO should be considered when it is not.
Keywords: Cannulation; Children; ECMO; Pediatric surgery.
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