Management of vascular access for extracorporeal life support: A cohort study

Staying in Place: In Vitro Comparison of Extracorporeal Membrane Oxygenation Cannula Fixation for Dislodgment Prevention

Background/Objectives: Secure large-bore cannula insertion is critical for effective extracorporeal membrane oxygenation (ECMO), as inadequate fixation can lead to complications such as infection, dislodgment, and life-threatening events. With inconsistent guidelines for ECMO line management, this study compares the effectiveness of traditional suture fixation to an adhesive securement method in the prevention of ECMO cannula dislodgment using an in vitro model. Methods: Porcine skin and muscle tissue sections were prepared and mounted in a custom holder. A 21F venous ECMO cannula was inserted using a modified Seldinger technique. Three fixation methods were randomly compared: (1) three silk sutures, and (2a) one silk suture with a CathGrip adhesive anchoring device. In addition, a sub-analysis was performed using (2b) the Hollister adhesive anchoring device. A uniaxial testing machine simulated 50 mm cannula dislodgment, measuring tensile forces at 12.5, 25, and 50 mm dislodgment points. Results: A total of 26 ECMO cannula fixations using sutures, 26 with adhesive CathGrip, six with a Hollister device, and three controls were tested across six porcine samples. Sutures demonstrated greater variability in force at maximum dislocation, with 27% rupturing at 50 mm. In contrast, CathGrip provided greater flexibility without tearing. The adhesive exhibited higher stiffness (2.38 N/mm vs. 2.09 N/mm, p < 0.001) and dislodgment energy (0.034 J vs. 0.032 J, p = 0.002) in the 0-5 mm range, while sutures showed greater stiffness in the 5-50 mm range (1.42 N/mm vs. 1.18 N/mm, p < 0.001). At larger displacements (25 mm and 50 mm) and in total energy absorption, no statistically significant differences were observed (p = 0.57). In a sub-analysis, the six fixations using the Hollister device exhibited higher variability and significantly lower dislodgment forces at 25 mm (p = 0.033) and 50 mm (p = 0.004) compared to the CathGrip device. Conclusions: This study suggests that adhesive anchoring methods, such as CathGrip, may provide comparable or potentially superior fixation strength to sutures for ECMO cannula stabilization under controlled conditions. However, further research, including clinical trials, is necessary to confirm these findings, evaluate long-term performance, and explore the implications for dislodgment risk and infection prevention in clinical practice.

One hundred ECMO retrivals before and during the Covid-19 pandemic: an observational study

OBJECTIVES

Patients with severe acute respiratory distress syndrome may require veno-venous extracorporeal membrane oxygenation (V-V ECMO) support. For patients in peripheral hospitals, retrieval by mobile ECMO teams and transport to high-volume centers is associated with improved outcomes, including the recent COVID-19 pandemic. To enable a safe transport of patients, a specialised ECMO-retrieval program needs to be implemented. However, there is insufficient evidence on how to safely and efficiently perform ECMO retrievals. We report single-centre data from out-of-centre initiations of VV-ECMO before and during the COVID-19 pandemic.

DESIGN & SETTING

Single-centre retrospective study. We include all the retrievals performed by our ECMO centre between January 1st, 2014, and April 30th, 2021.

RESULTS

One hundred ECMO missions were performed in the study period, for a median retrieval volume of 13 (IQR: 9-16) missions per year. the cause of the acute respiratory distress syndrome was COVID-19 in 10 patients (10 %). 98 (98 %) patients were retrieved and transported to our ECMO centre. To allow safe transport, 91 of them were cannulated on-site and transported on V-V ECMO. The remaining seven patients were centralised without ECMO, but they were all connected to V-V ECMO in the first 24 hours. No complications occurred during patient transport. The median duration of the ECMO mission was 7 hours (IQR: 6-9, range: 2 - 17). Median duration of ECMO support was 14 days (IQR: 9-24), whereas the ICU stay was 24 days (IQR:18-44). Overall, 73 patients were alive at hospital discharge (74 %). Survival rate was similar in non-COVID-19 and COVID-19 group (73 % vs 80 %, p = 0.549).

CONCLUSION

In this single-centre experience, before and during COVID-19 era, retrieval and ground transportation of ECMO patients was feasible and was not associated with complications. Key factors of an ECMO retrieval program include a careful selection of the transport ambulance, training of a dedicated ECMO mobile team and preparation of specific checklists and standard operating procedures.