Neck Cannulation for Extracorporeal Membrane Oxygenation Support in a 2-Year-Old Child with Acute Myocarditis
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CASE REPORT
Neck Cannulation for Extracorporeal Membrane Oxygenation Support in a 2-Year-Old Child with Acute Myocarditis Kanakis M1, Grisbolaki Evangelia1, Bobos D1, Lioulias A2, Alexiou K3, Giannopoulos N1
Abstract The first case in Greece is described of peripheral extracorporeal membrane oxygenation (ECMO) support via neck cannulation in a 2-year-old boy. The advantages and technical details of this method are explained. Key words: ECMO, peripheral, neck cannulation
Introduction
Technique
Extracorporeal life support is applied to sustain hemodynamic equilibrium and gas exchange, in order to facilitate end-organ recovery, to provide salvage therapy during acute cardiorespiratory failure or bridging transplant [1]. Advances in extracorporeal technology and appropriate patient selection have increased applications of extracorporeal membrane oxygenation (ECMO) over the last decade to a remarkable degree. Current applications include more challenging cases of reversible causes of respiratory failure or cardiogenic shock refractory to conventional treatment [2].
The neck was extended and tilted to the left approximately 30–45°. Skin preparation and site draping were applied. A 2.5-cm length incision was made about 1.5-cm above the clavicle, along the topographical landmark of the medial border of sternocleidomastoid muscle. The right internal jugular vein and common carotid artery were identified by retracting the sternocleidomastoid muscle laterally, identifying and preserving the vagus nerve (Figure 1). The right internal jugular vein and right common carotid artery were dissected. Silk sutures (No 1) were passed around the vessels both proximally and distally to the intended cannulation site to prevent bleeding and to secure the cannulas. After a bolus dose of 100 IU/kg unfractionated heparin, the right common carotid artery was tied cranially and a vascular clamp was applied caudally. The anterior half of the vessel was opened with a transverse incision and a 12Fr size arterial cannula was advanced to a depth of 2–3 cm adjacent to the anatomic landmark of the angle of Louis,
Case report A previously healthy 2-year-old boy weighing 9kg was referred as an emergency to our center for the management of fulminant myocarditis. On admission the boy was in refractory cardiogenic shock despite full inotropic support. Transthoracic echocardiogram suggested a left ventricular ejection fraction (LVEF) of 0.10 and moderate mitral regurgitation, supporting the diagnosis of acute systolic heart failure subsequent to fulminant myocarditis. ECMO support was commenced at bedside in the intensive care unit (ICU) under general anesthesia (GA).
1
Department of Pediatric and Congenital Heart Surgery, Onassion Cardiac Surgery Center, Athens, Greece
2
Department of Thoracic Surgery Department of Surgery Sismanoglio General Hospital of Athens, Greece 3
Corresponding author: Meletios Kanakis Department of Pediatric and Congenital Heart Surgery, Onassion Cardiac Surgery Center, Athens, Greece Tel.: +30 6945955085, e-mail: melet
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