WOFAPS 2025 8th World Congress of Pediatric Surgery

Lucas Moratilla-Lapeña, María del Carmen Sarmiento, Alejandro Madurga, Maria Lopez-Canelada, Juvenal Rey, Iñigo Velasco, Carlos De La Torre, Paula Burgos, Jose Luis Encinas, Francisco Hernandez-Oliveros

Hospital Universitario La Paz

---

Aim of the study:

Indications for ECMO increase as well as its usefulness in various situations; however, there are no guidelines for ECMO cannulation techniques. Our objective is to describe the complications and disparity in management.

Methods:

Unicentric retrospective review of children undergoing cervical ECMO (2016-2023) investigating: demographics variables, ECMO technique, cannula size, complications categorized by ELSO, mortality and post-ECMO medical control. Surgeon [pediatric (PS) or cardiothoracic (CS)] was registered.

Results:

Twenty-seven patients underwent ECMO (19 PS). Main indication was CDH (10/27;37%). All CS used purse-string suture at cannulation while only 1 PS did. Global complication rate was 20/27;74%, most frequently related to mechanical causes (14/27;51,9%) and being most frequent in PS group related to clots and malposition. Bleeding at the surgical place requiring intervention was 2/19 in PS and 2/8 in CS patients. All the patients treated with a 6Fr cannula died due to hemolysis or pump failure. At decannulation, all CS repaired both vessels while PS did artery repair and vein ligation, with heterogeneous heparinization and antiplatelet therapy regimens. In those patients with ultrasound after 6 months, patency rates were: repaired veins 25%(1/4) and repaired arteries 100%(5/5)(CS) and 80%(4/5)(PS).

Conclusion:

ECMO cannulation is associated with high rates of complications and great heterogeneity in technique and postoperative management. Mechanical or hemorrhagic complications and arterial and venous thrombosis were more frequent in PS group. Six Fr cannula is associated with high mortality related to the cannula itself; eventually an elective central ECMO should be evaluated.