Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO)/Extracorporeal Life Support (ECLS) - Removal of Peripheral (Arterial and/or Venous) Cannula(e), Open, Birth through 5 Years of Age

Summary

This procedure involves the removal of tubes (cannulae) that were previously inserted into a child's blood vessels to provide mechanical support to their heart and lungs.

Purpose

This procedure is performed to safely remove the cannulae after the need for ECMO/ECLS has ended. The primary goal is to restore natural blood flow without mechanical assistance.

Indications

• Successful weaning off ECMO/ECLS.
• Stabilization of heart and lung function.
• Physician's assessment indicating no further need for extracorporeal support.

Preparation

• Fasting for a specified period prior to the procedure.
• Evaluation of the child's overall health and readiness to come off ECMO/ECLS.
• Blood tests and imaging studies to assess the patient’s condition.

Procedure Description

1. The child is placed under general anesthesia to ensure they are asleep and do not feel pain.
2. The physician makes an incision over the site where the cannula(e) are inserted.
3. Cannulae are carefully removed from the blood vessels.
4. The blood vessels and incision site are then closed and sutured.
5. The area is cleaned and dressed to prevent infection.

Duration

Typically takes around 1 to 2 hours.

Setting

Performed in a hospital operating room or a specialized intensive care unit.

Personnel

• Pediatric surgeons
• Anesthesiologists
• Surgical nurses
• ECMO specialists

Risks and Complications

• Infection at the site of cannula removal
• Bleeding or blood clots
• Vascular injury
• Pain or discomfort at the incision site

Benefits

• Allows for the natural function of heart and lungs to resume.
• Reduces the risks associated with prolonged use of ECMO/ECLS.
• Promotes recovery and improves overall prognosis.

Recovery

• Close monitoring in the intensive care unit post-procedure.
• Pain management with appropriate medications.
• Instructions for wound care and potential activity restrictions.
• Follow-up appointments to ensure proper healing and cardiovascular function.

Alternatives

• Continuing ECMO/ECLS if criteria for removal are not met.
• Transition to other forms of mechanical ventilation if necessary.
• Each alternative has its own risks, benefits, and is considered based on individual patient condition.

Patient Experience

• The child will be under anesthesia during the procedure and will not feel pain.
• Post-procedure discomfort or pain at the incision site, managed with pain relief measures.
• Gradual resumption of normal activities as tolerated, under medical guidance.