Cannula Position Confirmation before Transportation of Veno-Venous ECMO Patients is Not Necessary: A Mobile ECMO Program Experience

Abstract

<h3>Purpose</h3> Mobile ECMO program supports patients with refractory acute respiratory failure deemed at high risk for transfer to an ECMO center. Transesophageal or transthoracic echocardiography and/or radiographic imaging is routinely done to confirm cannula position before departure to the receiving center. We herein report the feasibility and outcomes of the first case-series with transportation of VV-ECMO patients without confirmatory imaging. <h3>Methods</h3> Adult patients who underwent mobile VV-ECMO implantation. <h3>Results</h3> 71 adult VV-ECMO recipients were included, all with dual cannula implant schema: 14 (19.7%) transferred without confirmation; median (inter-quartile range) age was 51 (18, 80) years, BMI was 33.05 (21.7, 62.8) and 43.7% were female. Baseline characteristics of patients were similar in groups with and without cannula confirmation (Table). No complications occurred during cannulation or transportation. Two cannula malpositions were identified: 1) imaging group - venous inflow was noted to course from right femoral vein to the left without flow issues and was changed at the sending center; 2) non-imaging group a "kink" in IVC cannula was noted after arrival without flow issues. <h3>Conclusion</h3> With the use of point of care ultrasound, line placement safety is drastically improved, and transportation of patients with ARDS on VV ECMO with a stable flow is feasible without cannula position confirmation. This approach can decrease resource utilization, healthcare cost and minimize out-of facility time for the implant team.