Programs in which pediatric ECMO cannulations are performed by pediatric intensivists?

[picuboo]

Came across this article in SCCM (SCCM | Concise Critical Appraisal: Rapid Implementation of an Intensivist-Led VV ECMO Cannulation Program) which led me to wonder…

Are there any PICUs where attending intensivists (and even fellows) are trained to perform bedside ECMO cannulation? I know that this is a procedure traditionally done by surgeons, maybe interventional cardiologists. But there is variability across hospitals regarding which procedures peds crit care attendings perform in the unit (e.g., chest tubes done by surgery vs PICU), and am curious as to if there are certain programs that are trending towards training pediatric intensivists in ECMO cannulation.

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[Radetzky]

Those were adult patients. Most kids will be too small to cannulation percutaneously and require surgical cutdown.

 

[picuboo]

Those were adult patients. Most kids will be too small to cannulation percutaneously and require surgical cutdown.

I know they’re adults, but it’s my understanding that there are children that are able to undergo percutaneous cannulation via Seldinger (this is the practice at my current hospital). If percutaneous cannulation fails, pediatric CT surgery does cut-down.

Also, in this study (Pediatric extracorporeal membrane oxygenation: Our experience with single-vessel cannulation) of 9 patients aged 0.3 to 7.4 years, 7/9 of them were percutaneously cannulated via Seldinger technique successfully before VV-ECMO. They also cite several cases/studies in which many patients under 5 kg or younger than 1 year old had underwent percutaneous cannulation.

 

[JW2020]

The adult doctor comes into a peds thread, lumps 30+ specialties into one field, calls it “peds” and grumbles about stuff. Very helpful

 

[Radetzky]

I know they’re adults, but it’s my understanding that there are children that are able to undergo percutaneous cannulation via Seldinger (this is the practice at my current hospital). If percutaneous cannulation fails, pediatric CT surgery does cut-down.

Also, in this study (Pediatric extracorporeal membrane oxygenation: Our experience with single-vessel cannulation) of 9 patients aged 0.3 to 7.4 years, 7/9 of them were percutaneously cannulated via Seldinger technique successfully before VV-ECMO. They also cite several cases/studies in which many patients under 5 kg or younger than 1 year old had underwent percutaneous cannulation.

Interesting. Well, you learn something new everyday.

 

[SurfingDoctor]

None.

We have talked about it but the reality is: why bother? No one crashes on VV ECMO so you might as well get the most experienced people to do it in a controlled fashion.

 

[Stitch]

No reason to do this. Very easy to perf or shear a small vessel and then be unable to control. You’ll get away with it until you don’t. As noted you don’t crash onto vv and a good system can cannulate quickly enough with proper monitoring and planning. I’ll stick with central lines, dialysis caths and chest tubes.

 

[SurfingDoctor]

The adult doctor comes into a peds thread, lumps 30+ specialties into one field, calls it “peds” and grumbles about stuff. Very helpful

Actually, I think they are a peds resident. They just would prefer to talk trash about it and not be constructive. It happens.

 

[WheezyBaby]

I'm blanking out on the center but recently heard of one where PICU was in the process of taking over for VV cannulation. While it's something that certainly can be done, I'd be hard pressed to justify it from a patient care standpoint when ped surg is readily available. Likewise, I know there was a center I believe in India where peds intensivists were trained to place Codman's, but elsewhere with ready access to neurosurgery... why?