Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), open, 6 years and older
CPT4 code
Name of the Procedure:
Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS); removal of peripheral (arterial and/or venous) cannula(e), open, 6 years and older.
Summary
Extracorporeal membrane oxygenation (ECMO) is a life-support technique used to provide prolonged cardiac and respiratory support by oxygenating the patient's blood outside the body. This specific procedure involves the open removal of the peripheral cannulas (tubes) that were inserted to connect the patient's blood circulation to the ECMO system.
Purpose
ECMO is used to support patients when their heart and/or lungs are unable to function adequately on their own. This procedure involves removing the cannulas from older children or adults, 6 years and older, once ECMO therapy is no longer necessary.
Indications
- Severe respiratory or cardiac failure unresponsive to conventional treatments.
- Post-cardiac surgery patients with compromised heart/lung function.
- Acute respiratory distress syndrome (ARDS) or severe pneumonia.
- Patients meeting recovery criteria where ECMO support is no longer needed.
Preparation
- Pre-procedure physical examination and history review.
- Imaging studies such as x-rays or ultrasounds to confirm cannula position.
- Blood tests to monitor coagulation status.
- Fasting for several hours if general anesthesia is used.
- Adjustment of anticoagulant medication to reduce bleeding risks.
Procedure Description
- The patient is placed under general anesthesia or deep sedation.
- The surgical area around the cannulation site is cleaned and sterilized.
- An incision is made to access the cannulas.
- The cannulas are carefully clamped to avoid air or blood embolisms.
- The cannulas are then gently removed.
- The incision is sutured closed, and a sterile dressing is applied.
Duration
The procedure typically takes 30 to 60 minutes.
Setting
Performed in a hospital operating room or a specialized intensive care unit (ICU).
Personnel
- Cardiothoracic surgeon or intensivist.
- Anesthesiologist.
- Surgical nurses and technicians.
- Perfusionist (sometimes present).
Risks and Complications
Common Risks:
- Bleeding at the cannula site
- Infection Rare Risks:
- Air embolism
- Vascular damage
- Hematoma formation Complications are managed by the surgical team and may require additional interventions.
Benefits
- Allows discontinuation of ECMO support when natural heart/lung function is sufficient.
- Reduces the risk of prolonged ECMO-associated complications (e.g., infection, clotting).
- Promotes recovery and physical rehabilitation.
Recovery
- Close monitoring in the ICU post-procedure.
- Regular wound care instructions to ensure proper healing.
- Antimicrobial medication to prevent infection.
- Pain management with prescribed analgesics.
- Expected recovery time is usually a few days, but it varies based on the patient's overall health.
Alternatives
- Continuation of ECMO support if removal criteria are not met.
- Transition to other forms of respiratory or cardiac support if applicable.
- Each alternative has its own risks and benefits that should be discussed with the healthcare team.
Patient Experience
- Patients might feel some discomfort or pain at the cannulation site post-removal, which is managed with pain medication.
- Patients often feel anxious, but support from the healthcare team and family can help alleviate concerns.