Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO) / Extracorporeal Life Support (ECLS); Reposition Peripheral Cannula, Birth through 5 Years (includes fluoroscopic guidance)

Summary

ECMO/ECLS is a life-saving procedure where a machine temporarily takes over the work of the heart and lungs. This specific procedure involves repositioning the cannulae (tubes) placed in the child's blood vessels to ensure proper function and effectiveness, with guidance from fluoroscopy (a type of X-ray).

Purpose

ECMO/ECLS is used to provide circulatory and respiratory support to critically ill children who have severe but potentially reversible heart or lung conditions. The procedure helps maintain oxygenation and circulation while the underlying issue is treated or resolved.

Indications

• Severe respiratory failure unresponsive to conventional treatments
• Cardiac failure or arrest
• Severe infections affecting heart and lungs
• Post-surgical support for heart surgeries
• Congenital heart disease

Preparation

• Fasting as per doctor’s instructions, typically for a few hours before the procedure
• Medication adjustments, might include stopping certain medications
• Pre-procedure tests such as blood tests, echocardiograms, and chest X-rays

Procedure Description

1. Preparation: The patient is sedated and connected to a ventilator if not already done.
2. Initial Setup: The previously placed ECMO cannulae are assessed.
3. Repositioning: Using fluoroscopic guidance, the physician carefully repositions the arterial and/or venous cannulae to enhance ECMO efficiency.
4. Adjustment Check: Fluoroscopy confirms the new position, ensuring optimal blood flow.
5. Monitoring: Continuous monitoring of the patient's vital signs and ECMO parameters.

Tools/Equipment:

• ECMO machine
• Peripheral cannulae
• Fluoroscope (X-ray machine)
• Sedation/anesthesia equipment

Duration

The procedure typically takes 1 to 2 hours.

Setting

This procedure is performed in a hospital setting, often in the Intensive Care Unit (ICU) or an operating room.

Personnel

• Pediatric intensivist or ECMO specialist
• Pediatric surgeons
• Radiologist (for fluoroscopic guidance)
• Nurses
• Anesthesiologists

Risks and Complications

• Bleeding or hematoma at cannula sites
• Infection
• Blood clots
• Air embolism
• Cannula dislodgment
• Complications from sedation or anesthesia

Benefits

• Stabilizes the child's condition by improving oxygenation and circulation
• Provides critical support allowing underlying conditions to be treated
• Potentially life-saving for severe heart or lung failure

Recovery

• Close monitoring in the ICU
• Pain management and sedation adjustments
• Regular blood tests and imaging to assess progress
• Follow-up appointments with cardiologists and specialists

Alternatives

• Conventional mechanical ventilation
• Medications to support heart and lung function
• Heart-lung transplant (in very severe cases)

Pros:

• Less invasive than ECMO
• Immediate start without need for surgical expertise

Cons:

• May not be sufficient for severe cases
• Not all patients are eligible for alternative treatments

Patient Experience

During the procedure, the child will be sedated and should not feel pain. Post-procedure, they may experience some discomfort at cannula sites managed by pain relief measures. Parents should expect detailed guidance and support from the medical team to assist in their child’s recovery.