33958 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed)

Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO)/Extracorporeal Life Support (ECLS) with Repositioning of Peripheral Cannula(e), Percutaneous, 6 Years and Older (Includes Fluoroscopic Guidance, When Performed)

Summary

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is a life-saving procedure where blood is oxygenated outside the body, commonly used for patients with severe respiratory or cardiac failure. This specific procedure involves the percutaneous repositioning of arterial or venous cannula(e) under fluoroscopic guidance for patients aged 6 years and older.

Purpose

The purpose of ECMO/ECLS is to support patients with life-threatening heart or lung conditions by providing oxygen to the blood and removing carbon dioxide outside of the body, essentially acting as an artificial heart-lung machine. The repositioning procedure ensures optimal placement of cannula(e) for efficient blood flow and oxygenation.

Indications

• Severe respiratory failure
• Cardiac failure unresponsive to conventional treatments
• Persistent hypoxemia (low blood oxygen levels)
• Cardiac or respiratory arrest
• Post-surgical support for heart or lung conditions

Preparation

• Fasting for a specified period before the procedure
• Adjustment or discontinuation of certain medications as advised by the physician
• Pre-procedure diagnostic tests such as blood tests, imaging studies, and ECGs to assess the patient’s overall health

Procedure Description

1. Preparation and Anesthesia: The patient is prepared and given anesthesia or sedation for comfort.
2. Cannulae Repositioning: Using percutaneous techniques, the physician repositions the arterial and/or venous cannula(e).
3. Fluoroscopic Guidance: Real-time imaging (fluoroscopy) is used to guide the correct placement of the cannula(e).
4. Monitoring and Adjustment: The placement is confirmed, and adjustments are made to ensure optimal blood flow and gas exchange.
5. Completion: The procedure is completed, and the patient is closely monitored.

Duration

The procedure typically takes around 1 to 2 hours, depending on the complexity and patient's condition.

Setting

This procedure is performed in a hospital setting, usually in an intensive care unit (ICU) or dedicated ECMO unit.

Personnel

• Cardiothoracic Surgeon or Interventional Radiologist
• Anesthesiologist
• Critical Care Nurses
• ECMO Specialist or Perfusionist
• Radiologic Technologist

Risks and Complications

• Bleeding or hematoma
• Infection at the cannula site
• Vascular injury or thrombosis
• Air embolism
• Malpositioning of cannula(e)
• Rare risk of organ damage

Benefits

• Stabilization of critical respiratory or cardiac function
• Potential to save life in severe cardiac or respiratory failure cases
• Immediate improvement in oxygenation and CO2 removal

Recovery

• Continuous monitoring in an ICU
• Post-procedure imaging to confirm proper placement
• Pain management as needed
• Regular follow-up to monitor recovery and cannula site
• Patients may have activity restrictions and need specialized care for those on prolonged ECMO support

Alternatives

• Mechanical Ventilation: Provides respiratory support via a ventilator.
• Medications: Inotropes or vasopressors for cardiac support.
• Surgical Interventions: Heart or lung surgery for specific conditions.
• Pros and cons should be discussed with the healthcare team to choose the best treatment option.

Patient Experience

Patients are sedated or under general anesthesia during the procedure, so they should not feel pain. Post-procedure, they might experience soreness or discomfort at the cannula site, managed with appropriate pain relief measures. Regular updates and reassurance from the healthcare team will help ensure comfort and address any concerns during recovery.