P2.C050: Outcomes and Complications of Intensivist-Led Extracorporeal Membrane Oxygenation Cannulation in the Neonatal and Pediatric Populations

Background: Extracorporeal membrane oxygenation (ECMO) provides heart and/or lung bypass for critically ill patients. In pediatric patients, ECMO cannulation is typically performed by a surgeon, however, Cook Children’s Medical Center (CCMC) pediatric intensive care unit (PICU) is unique in that the pediatric intensivists often cannulate on their own or in combination with the surgeons. We aim to evaluate the outcomes of surgeon vs intensivist ECMO cannulation.

Methods: A single-center, retrospective chart review was performed on patients undergoing ECMO cannulation in the CCMC PICU from 01/01/2018-12/31/2023. Exclusion criteria included multiple ECMO cannulations during the hospitalization, history of prior ECMO cannulation, outside of CCMC PICU ECMO cannulation, and central ECMO cannulation approach. ECMO patients were divided into three groups dependent on the clinician(s) cannulating: intensivist and surgeon together, surgeon(s) solo, and intensivist(s) solo. Each group was assessed for outcomes including time from activation of ECMO to on ECMO termed time-to-cannulation (TTC), from timeout performance to on ECMO termed timeout (TO), morbidity, mortality, and complications. Complications included bleeding, infection, limb ischemia, thrombus, cannula-related problems, and ECMO circuit mechanical failure.

Results: 51 patients met the inclusion criteria for the study. 9 (18%) were cannulated by an intensivist(s) solo, 10 (20%) were cannulated by a combination of both intensivist and surgeon, and 32 (63%) were cannulated by a surgeon(s) solo. Intensivist(s) solo cannulation patients had a median TTC of 1.52 hours, median TO of 1.01 hours, and median ECMO run duration of 1.52 days. Intensivist and surgeon combined cannulation had a median TTC of 1.22 hours, median TO of 0.36 hours, and median ECMO run duration of 7.04 days. The surgeon(s) solo cannulation group had a median TTC of 1.39 hours, median TO of 0.64 hours, and median ECMO run duration of 5.93 days. Surgeon(s) solo cannulation had 17 of 32 patients (53%) experienced complications, the most common being bleeding in 9 patients. Intensivist(s) solo cannulation had 3 of 9 (33%) patients experience complications and intensivist and surgeon combined cannulation had 3 of 10 (30%) experience complications. Intensivist(s) solo had 7 out of 8 (88%) patients survive decannulation and hospital discharge. Intensivist and surgeon combined cannulation had 5 out of 8 (63%) patients survive decannulation and hospital discharge. Surgeon(s) solo had 24 out of 36 (66%) patients survive decannulation, with 20 of those 24 surviving to hospital discharge.

Conclusion: Intensivist-led cannulation results in slower TTC, lower morbidity, and shorter ECMO duration compared to surgeons. Surgeon-led cannulation is linked to shorter TTC, more complications, and extended ECMO duration. Surgeon and intensivist combined cannulation yield the shortest TTC, TO, and lowest morbidity rate. These findings suggest there may be potential benefits to surgeons and intensivists cannulating patients together.