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J Pediatr Surg. 2019 Oct 25. pii: S0022-3468(19)30723-7. doi: 10.1016/j.jpedsurg.2019.09.070. [Epub ahead of print]

Safety of Delayed Decannulation of Venoarterial Cannulas in Patients with Congenital Diaphragmatic Hernia.

Author information

1
Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI.
2
Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI. Electronic address: samirg@med.umich.edu.

Abstract

BACKGROUND:

The practice of "cutting-away" from venoarterial extracorporeal life support (ECLS) and leaving indwelling heparinized cannulas prior to decannulation is controversial. This study aims to determine the safety and efficacy of this strategy in patients with congenital diaphragmatic hernia (CDH) who require ECLS.

METHODS:

A single-center retrospective review of electronic health records was performed on all patients with CDH who underwent elective ECLS decannulation between January 2014 and September 2018. Descriptive statistics are presented as medians with interquartile range.

RESULTS:

Seventy-three percent (19/26) of patients who underwent venoarterial ECLS for CDH were electively decannulated. After a median ECLS run of 10.7 days [6.1-19.5], patients were "cut-away" for a median of 26 h [19.8-43] prior to decannulation. One patient required re-initiation at 36 h for a pulmonary hypertensive crisis (5%). There were no major bleeding or embolic events while "cut-away", and four (21%) patients had clots removed from the cannulas without clinical sequelae. One patient was recannulated 16 days following initial decannulation.

CONCLUSIONS:

Our data suggests that "cutting-away" from ECLS in patients with congenital diaphragmatic hernia is safe and allows a period of observation without significant complications. This strategy may be particularly helpful in patients at risk for recannulation, but better prognostic criteria are needed.

LEVEL OF EVIDENCE:

Level IV.

TYPE OF STUDY:

Treatment Study.

KEYWORDS:

CDH; Cannulation; Decannulation; ECLS; ECMO; Venoarterial

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