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Abstract：
BACKGROUND: No studies exist comparing various femoral artery cannula sizes in children on ECMO. We hypothesize that smaller arterial cannulas provide adequate flow in children while decreasing vascular complications.
METHODS: We performed a retrospective review of the ELSO database from 2012-2017. We included children undergoing femoral venoarterial ECMO between ages 12 and 18 years and weighing more than 30 kg. Arterial cannula sizes were grouped as: 15-16Fr, 17-18Fr, 19-20Fr and ≥21Fr. Arterial pump flow, bleeding complications, limb ischemia, and mechanical complications were compared by cannula size. Distal perfusion catheter and percutaneous placement were also compared for complications.
RESULTS: A total of 429 patients were included with 28.2% 15-16Fr, 32.2% 17-18Fr, 22.8% 19-20Fr, and 16.8% ≥ 21Fr arterial femoral cannulas. Median age was lower in the 15-16Fr group compared to the largest cannula group (14.7 years vs 15.5 years, p < 0.01). The overall mean arterial flow was 57.4 +/- 17.0 mL/kg/min with no difference in mean arterial flow rates among the cannula size groups (p = 0.85). There were no significant differences in all complications, bleeding or mechanical complications by arterial cannula size group. However, there was an increased risk of limb ischemia in the ≥21Fr group compared to the 15-16Fr group (OR 4.38, 95% CI 1.24-15.43; p = 0.02). Distal perfusion catheter was shown to increase the risk of mechanical complications (OR 1.78; 95% CI 1.03-3.07; p = 0.04) but did not make a statistically significant difference in limb ischemia (OR 0.37; 95% CI 0.12-1.11; p = 0.07).
CONCLUSIONS: Review of the ELSO database demonstrates that the use of larger arterial cannulas compared to 15-16Fr cannulas are not needed to achieve similar pump flows for hemodynamic support but the largest cannula sizes may increase the risk of ischemic complications.
METHODS: We performed a retrospective review of the ELSO database from 2012-2017. We included children undergoing femoral venoarterial ECMO between ages 12 and 18 years and weighing more than 30 kg. Arterial cannula sizes were grouped as: 15-16Fr, 17-18Fr, 19-20Fr and ≥21Fr. Arterial pump flow, bleeding complications, limb ischemia, and mechanical complications were compared by cannula size. Distal perfusion catheter and percutaneous placement were also compared for complications.
RESULTS: A total of 429 patients were included with 28.2% 15-16Fr, 32.2% 17-18Fr, 22.8% 19-20Fr, and 16.8% ≥ 21Fr arterial femoral cannulas. Median age was lower in the 15-16Fr group compared to the largest cannula group (14.7 years vs 15.5 years, p < 0.01). The overall mean arterial flow was 57.4 +/- 17.0 mL/kg/min with no difference in mean arterial flow rates among the cannula size groups (p = 0.85). There were no significant differences in all complications, bleeding or mechanical complications by arterial cannula size group. However, there was an increased risk of limb ischemia in the ≥21Fr group compared to the 15-16Fr group (OR 4.38, 95% CI 1.24-15.43; p = 0.02). Distal perfusion catheter was shown to increase the risk of mechanical complications (OR 1.78; 95% CI 1.03-3.07; p = 0.04) but did not make a statistically significant difference in limb ischemia (OR 0.37; 95% CI 0.12-1.11; p = 0.07).
CONCLUSIONS: Review of the ELSO database demonstrates that the use of larger arterial cannulas compared to 15-16Fr cannulas are not needed to achieve similar pump flows for hemodynamic support but the largest cannula sizes may increase the risk of ischemic complications.
摘要：
背景：目前尚无研究比较ECMO患儿的各种股动脉套管大小。我们假设较小的动脉插管为儿童提供足够的流量，同时减少血管并发症。
方法：我们对2012-2017年的ELSO数据库进行了回顾性审查。我们包括12至18岁，体重超过30公斤的接受股静脉动脉ECMO的儿童。动脉插管的大小分为：15-16Fr，17-18Fr,19-20Fr和≥21Fr。动脉泵流量,出血并发症,肢体缺血,和机械性并发症通过套管大小进行比较。还比较了远端灌注导管和经皮放置的并发症。
结果：共纳入429例患者，占28.2%，15-16Fr，32.2%17-18Fr，22.8%19-20Fr，16.8%≥21Fr动脉股动脉插管。与最大插管组相比，15-16Fr组的中位年龄较低（14.7岁vs15.5岁，p<0.01)。总体平均动脉流量为57.4+/-17.0mL/kg/min，插管大小组之间的平均动脉流量没有差异（p=0.85）。所有并发症均无显著差异，出血或机械并发症按动脉插管大小组。然而,与15-16Fr组相比,≥21Fr组的肢体缺血风险增加(OR4.38,95%CI1.24-15.43;p=0.02).远端灌注导管显示增加机械并发症的风险（OR1.78;95％CI1.03-3.07;p=0.04），但在肢体缺血方面没有统计学差异（OR0.37;95％CI0.12-1.11;p=0.07）。
结论：对ELSO数据库的审查表明，与15-16Fr插管相比，不需要使用更大的动脉插管来实现类似的血流动力学支持泵流量，但最大的插管尺寸可能会增加缺血性并发症的风险。
方法：我们对2012-2017年的ELSO数据库进行了回顾性审查。我们包括12至18岁，体重超过30公斤的接受股静脉动脉ECMO的儿童。动脉插管的大小分为：15-16Fr，17-18Fr,19-20Fr和≥21Fr。动脉泵流量,出血并发症,肢体缺血,和机械性并发症通过套管大小进行比较。还比较了远端灌注导管和经皮放置的并发症。
结果：共纳入429例患者，占28.2%，15-16Fr，32.2%17-18Fr，22.8%19-20Fr，16.8%≥21Fr动脉股动脉插管。与最大插管组相比，15-16Fr组的中位年龄较低（14.7岁vs15.5岁，p<0.01)。总体平均动脉流量为57.4+/-17.0mL/kg/min，插管大小组之间的平均动脉流量没有差异（p=0.85）。所有并发症均无显著差异，出血或机械并发症按动脉插管大小组。然而,与15-16Fr组相比,≥21Fr组的肢体缺血风险增加(OR4.38,95%CI1.24-15.43;p=0.02).远端灌注导管显示增加机械并发症的风险（OR1.78;95％CI1.03-3.07;p=0.04），但在肢体缺血方面没有统计学差异（OR0.37;95％CI0.12-1.11;p=0.07）。
结论：对ELSO数据库的审查表明，与15-16Fr插管相比，不需要使用更大的动脉插管来实现类似的血流动力学支持泵流量，但最大的插管尺寸可能会增加缺血性并发症的风险。
