open access

Vol 48, No 4 (2016)
Original and clinical articles
Published online: 2016-09-29
Submitted: 2016-05-28
Accepted: 2016-09-23
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Safety of intensivist-led bedside decannulation of internal jugular bi-caval dual-lumen veno-venous extracorporeal membrane oxygenation cannulas and report of technique

Aaron Heller, John Dollerschell, Joshua Burk, Hailey Haines, Jonathan Kozinn
DOI: 10.5603/AIT.a2016.0040
·
Pubmed: 27689428
·
Anaesthesiol Intensive Ther 2016;48(4):211-214.

open access

Vol 48, No 4 (2016)
Original and clinical articles
Published online: 2016-09-29
Submitted: 2016-05-28
Accepted: 2016-09-23

Abstract

BACKGROUND: In the past decade, the rate and utilization of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has increased dramatically. A single catheter technique has recently come into favour for providing VV-ECMO. Although it has been shown that intensivists can safely place these catheters, the safety of decannulation by intensivists has not been reported in the literature.

OBJECTIVE: We describe a technique for safely decannulating the Avalon Elite VV-ECMO catheter at the bedside and assess the safety of this technique, as compared with the standard technique of decannulation in the operating room by a surgeon.

METHODS: This was a retrospective cohort design conducted at a tertiary care cardiovascular intensive care unit at an academic medical centre. All patients who underwent VV-ECMO from 2009 to 2014 were included in the study except for those who had been decannulated for withdrawal of care. Complication rates from decannulation were compared between patients who were decannulated by surgeons in the operating room and those decannulated by intensivists in the intensive care unit (ICU). Results: Twenty-eight patients were included in this study, of whom twenty-three patients (82%) were decannulated by intensivists, board certified in Critical Care Medicine through the American Board of Anesthesiology, while five (18%) the patients were decannulated by a surgeon. There was no significant difference in the complications rates between the surgeons (0) and intensivists (1) (P = 1.00). There were no major complications requiring operative intervention associated with decannulation identified in this study.

CONCLUSIONS: It is safe for intensivists to decannulate the Avalon Elite VV-ECMO cannula in the ICU using our purse-string suture technique. Performing these decannulations at the bedside compared to operating room may have positive clinical ramifications that include improved patient safety, timely patient care and reduced operating room costs.

Abstract

BACKGROUND: In the past decade, the rate and utilization of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has increased dramatically. A single catheter technique has recently come into favour for providing VV-ECMO. Although it has been shown that intensivists can safely place these catheters, the safety of decannulation by intensivists has not been reported in the literature.

OBJECTIVE: We describe a technique for safely decannulating the Avalon Elite VV-ECMO catheter at the bedside and assess the safety of this technique, as compared with the standard technique of decannulation in the operating room by a surgeon.

METHODS: This was a retrospective cohort design conducted at a tertiary care cardiovascular intensive care unit at an academic medical centre. All patients who underwent VV-ECMO from 2009 to 2014 were included in the study except for those who had been decannulated for withdrawal of care. Complication rates from decannulation were compared between patients who were decannulated by surgeons in the operating room and those decannulated by intensivists in the intensive care unit (ICU). Results: Twenty-eight patients were included in this study, of whom twenty-three patients (82%) were decannulated by intensivists, board certified in Critical Care Medicine through the American Board of Anesthesiology, while five (18%) the patients were decannulated by a surgeon. There was no significant difference in the complications rates between the surgeons (0) and intensivists (1) (P = 1.00). There were no major complications requiring operative intervention associated with decannulation identified in this study.

CONCLUSIONS: It is safe for intensivists to decannulate the Avalon Elite VV-ECMO cannula in the ICU using our purse-string suture technique. Performing these decannulations at the bedside compared to operating room may have positive clinical ramifications that include improved patient safety, timely patient care and reduced operating room costs.

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Keywords

extracorporeal membrane oxygenation, ECMO; decannulation; safety; intensive care unit

About this article
Title

Safety of intensivist-led bedside decannulation of internal jugular bi-caval dual-lumen veno-venous extracorporeal membrane oxygenation cannulas and report of technique

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 48, No 4 (2016)

Pages

211-214

Published online

2016-09-29

DOI

10.5603/AIT.a2016.0040

Pubmed

27689428

Bibliographic record

Anaesthesiol Intensive Ther 2016;48(4):211-214.

Keywords

extracorporeal membrane oxygenation
ECMO
decannulation
safety
intensive care unit

Authors

Aaron Heller
John Dollerschell
Joshua Burk
Hailey Haines
Jonathan Kozinn

References (10)
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  7. Conrad SA, Grier LR, Scott LK, et al. Percutaneous cannulation for extracorporeal membrane oxygenation by intensivists: a retrospective single-institution case series. Crit Care Med. 2015; 43(5): 1010–1015.
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