S. J. Clark2,3, F. Sheikh2,3, A. C. Akinkuotu2,3, I. J. Zamora2,3, T. C. Lee2,3, O. O. Olutoye2,3, A. Mehollin-Ray1,3, D. L. Cass2,3 1Baylor College Of Medicine,Radiology,Houston, TX, USA 2Baylor College Of Medicine,MIchael E. DeBakey Department Of Surgery,Houston, TX, USA 3Texas Children’s Fetal Center,Houston, TX, USA
Introduction: Infants with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO) may not be candidates for veno-venous (VV), and thus require veno-arterial (VA) ECMO, due to small right jugular vein sizes. The purpose of this study was to evaluate ECMO cannula types and sizes used in the treatment of infants with CDH, and to begin to determine whether prenatal imaging of right neck vessel size may help guide cannula selection.
Methods: The charts of all prenatally diagnosed neonates with CDH treated at a comprehensive fetal center from 2000 to 2013 were reviewed. Perinatal outcomes collected included fetal internal jugular vein (IJ) diameter as measured on fetal ultrasound, need for ECMO, ECMO cannula size, cannula cost, and number of cannulas used per operation.
Results: Of 201 CDH patients, 52 were treated with ECMO (6 VV and 47 VA) at mean day of life 2 ± 4 (range, 0-11 days). All patients treated with VV had 13 F cannulas, whereas those treated with VA ECMO had cannula sizes of 12 or 10 F venous and 10 or 8 F arterial. Thirty-two CDH patients had fetal measurement of right IJ size, of which 7 required ECMO. Of these 7, VV cannulation was attempted in 5 patients but successful only in the infant with prenatal right IJ size of > 4mm (Table 1). One patient was discovered to have an absent right IJ at attempted cannulation, and retrospective review of fetal imaging confirmed this finding. In total, 24 cannulas attempted on 22 patients (cost $349-$2699) were discarded at operation because they did not fit.
Conclusion: Many CDH patients cannulated for ECMO are not candidates for VV ECMO and/or have cannulas discarded from the surgical field due to inadequate right IJ vein size. Prenatal measurement of fetal neck vessels may be predictive of optimal cannula size, which may guide surgical management and maximize operative cost-savings.
