Original Research ARTICLE
SURGICAL EXPERTISE IN NEONATAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO): A SINGLE CENTER EXPERIENCE
- 1Department of Pediatric Surgery, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Italy
- 2Naonatal Intensive Care Unit, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Italy
- 3Department of Clinical and Community Sciences, Faculty of Medicine and Surgery, University of Milan, Italy
- 4Neonatal Intensive Care Unit, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Italy
- 5Betamed srl, Italy
- 6Pediatric Anesthesiology and Intensive Care Unit, Department of Anesthesia and Critical Care, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Italy
Introduction: The surgical technique for peripheral cannulation aimed to provide extracorporeal membrane oxygenation (ECMO) is well described. Training methods for surgeons still need a proper standardization, especially in newborn patients.
This study aims to evaluate the outcomes of surgical training of a neonatal ECMO team.
Materials and Methods: A five years training program (2014-2018) was developed to achieve the skills in the surgical technique for neonatal veno-arterial ECMO. Surgeons with experience in neonatal and vascular surgery were selected for the training. The training consisted of educational sessions, high-fidelity simulations, swine model in vivo procedures, international fellowship, and periodical simulations.
The preliminary clinical experience in surgical neonatal ECMO management (2016-present) was analyzed recording the following data: indications for ECMO and patients’ data; effectiveness of cannulations (number; perioperative complications of cannulation; major surgical events during ECMO); efficacy of de-cannulation (number and perioperative complications).
Results: 12 neonates (5 females) fitted the ELSO criteria for ECMO. Nine newborns were affected by CDH; 1 by H1N1 flu-related pneumonia; 1 by meconium aspiration syndrome and one by Respiratory Syncytial Virus related bronchiolitis.
Mean weight at cannulation was 3.281 g (range 2.330-3.840 g); mean gestational age was 36 weeks. No procedure was aborted, and no intra-operatory mortality was recorded. Mean operative time was 86±30 minutes. The carotideal cannula caliber ranged from 8F (8 patients) to 10F (2 patients); the jugular cannula caliber were: 8F cannula (2 patients), 10F (6 patients) and 12F (2 patients).
Four complications occurred: a case of air in the circuit, two cases of azygous vein cannulation and a partial dislocation of the venous cannula during the daily care maneuvers. All of them were promptly recognized and successfully treated.
The mean ECMO duration was 7.1 ± 4.2 days (range 2-16 days). Seven patients (78%) were decannulated effectively. Mean decannulation time was 53 minutes (range 45-80 minutes). No complications occurred during the decannulation process. No ECMO–related deaths were recorded.
Conclusions: Neonatal respiratory ECMO still represents a challenge. Experienced neonatal surgeons can manage the neck vascular cannulation. Adhesion to the codified procedure after an appropriate training and learning curve is mandatory.
Keywords: neonatal, Child, ECMO - extracorporeal membrane oxygenation, Surgery, training
Received: 28 May 2019;
Accepted: 13 Sep 2019.
Copyright: © 2019 Macchini, Di Cesare, Morandi, Ichino, Raffaeli, Conigliaro, Sorrentino, Neri, Mosca, Leva and Cavallaro. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: MD. Francesco Macchini, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Department of Pediatric Surgery, Milan, Italy, firstname.lastname@example.org