33962 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), open, 6 years and older (includes fluoroscopic guidance, when performed)

Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO)/Extracorporeal Life Support (ECLS); Reposition Peripheral Cannula(e)

Summary

This procedure involves repositioning the cannula(e) used in ECMO/ECLS for patients aged 6 years and older. ECMO/ECLS is a life-support technique that uses a machine to take over the work of the heart and lungs. The cannula(e) are tubes inserted into blood vessels to carry blood to and from the ECMO machine. Repositioning may be necessary to ensure proper function and placement.

Purpose

ECMO/ECLS is used to support patients whose heart and lungs need rest and healing. The goal is to allow the patient's heart and lungs to recover enough to function independently. Repositioning the cannula(e) is crucial for maintaining effective support and preventing complications.

Indications

• Severe heart or lung failure unresponsive to conventional treatments
• Conditions like severe acute respiratory distress syndrome (ARDS), heart attack, or post-cardiac surgery complications
• Patients requiring continued and optimized ECMO/ECLS support

Preparation

• Fasting as directed, typically starting 6-8 hours before the procedure
• Adjustments to medications as per physician advice
• Pre-procedure imaging studies, such as chest X-rays or ultrasounds, to assess cannula position

Procedure Description

1. Anesthesia/Sedation: The patient is typically sedated or under anesthesia.
2. Fluoroscopic Guidance: Real-time X-ray imaging is used to guide the repositioning.
3. Cannula Repositioning: The physician carefully moves the cannula(e) to the proper position.
4. Verification: Proper placement is confirmed via imaging and monitoring of blood flow and function.
5. Securing Cannulae: Once correctly positioned, the cannula(e) are securely fixed to minimize movement.

Duration

The procedure generally takes 1-2 hours, depending on complexity and patient condition.

Setting

Performed in a hospital setting, typically in an Intensive Care Unit (ICU) or Operating Room (OR).

Personnel

• Cardiac or thoracic surgeon
• Interventional radiologist
• Anesthesiologist
• Critical care nurses
• ECMO specialists

Risks and Complications

• Common Risks: Bleeding, infection, air embolism
• Rare Risks: Blood vessel damage, heart rhythm disturbances
• Management usually includes close monitoring, medications, and surgical correction if necessary.

Benefits

• Improved oxygenation and perfusion.
• Enhanced recovery potential for heart and lungs.
• Symptoms relief as soon as cannula(e) are properly repositioned.

Recovery

• Continuous monitoring in the ICU.
• Regular imaging studies to ensure cannula position.
• Physical care to prevent complications like blood clots.
• Recovery may take days to weeks, depending on the underlying condition and overall treatment response.

Alternatives

• Conventional mechanical ventilation
• Heart-lung bypass during surgery
• Pharmacological treatments Selecting an alternative depends on the severity of the condition and the patient's overall health.

Patient Experience

• The patient will be sedated or asleep and should not feel pain during the procedure.
• Post-procedure discomfort may include soreness or bruising at insertion sites, managed with pain relief measures.
• Continued sedation and support will likely be necessary in the ICU.

This comprehensive overview provides essential details for understanding the ECMO/ECLS cannula repositioning procedure, highlighting its significance, steps involved, and expected patient outcomes.