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Point-of-care ultrasound for the evaluation of venous cannula position in neonatal extracorporeal membrane oxygenation

Journal of Perinatology volume 41, pages 1645–1650 (2021)Cite this article

Subjects

Abstract

Objective

To assess the ability of point-of-care ultrasound (POCUS) to identify venous cannula position in neonates on extracorporeal membrane oxygenation (ECMO) and compare with conventional imaging.

Study design

Retrospective review of 37 infants on ECMO with 51 POCUS studies between January 2017 and October 2019. Studies were reviewed for identification of venous cannula location and compared with plain radiography and echocardiography. Kappa statistic and predictive values were calculated.

Results

Venous cannula tip position was identified in 90% of POCUS studies. Fifty percent of the cannula tips were malpositioned. Plain radiography, the most commonly used method for evaluating tip position, showed poor agreement (57%) with POCUS (kappa 0.13). There was substantial agreement (89%) between echocardiography and POCUS (kappa 0.78).

Conclusion

This study provides preliminary evidence that POCUS is more accurate than plain radiography for the evaluation of ECMO venous cannula position. Adoption of this practice may prevent potentially catastrophic ECMO complications.

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Fig. 1: Plain radiography and POCUS images of a venous cannula in a patient on venoarterial ECMO for meconium aspiration syndrome.

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Acknowledgements

We acknowledge the ECMO patients and their families who were included in this study and were cared for by our surgical and medical teams. In addition, we thank James Connelly, the manager of the ECMO Center at the Children’s Hospital of Philadelphia, for his contribution to this work.

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Authors and Affiliations

  1. Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Thomas W. Pawlowski, Jason Z. Stoller, Natalie E. Rintoul & María V. Fraga

  2. Department of Pediatric General, Thoracic and Fetal Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Holly L. Hedrick

  3. Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Michael D. Quartermain

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  1. Thomas W. Pawlowski
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  2. Jason Z. Stoller
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  3. Natalie E. Rintoul
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  4. Holly L. Hedrick
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  6. María V. Fraga
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All listed authors made substantial contributions to this work, were involved in the drafting or revising of this manuscript, and gave final approval for submission.

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Correspondence to Thomas W. Pawlowski.

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Pawlowski, T.W., Stoller, J.Z., Rintoul, N.E. et al. Point-of-care ultrasound for the evaluation of venous cannula position in neonatal extracorporeal membrane oxygenation. J Perinatol 41, 1645–1650 (2021). https://doi.org/10.1038/s41372-021-00936-8

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