SESSION TYPE: Pediatric Critical Care Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Single-venous venovenous (VV) extracorporeal membrane oxygenation (ECMO) is an evolving method of respiratory support in patients with acute respiratory failure. The development of animal models is needed to advance basic science and translational research in single-venous VV ECMO. Therefore, placement of a bicaval dual-lumen catheter using anatomical landmarks and confirmation using transthoracic echocardiography (TTE) with Doppler was done in piglets to develop an effective and efficient animal model.
METHODS: Five piglets between 4-6 weeks of age and weighing 9.4 ± 2.0 kg initially received mechanical ventilation for 1 hour (respiratory rate 14-20 breaths/min, tidal volume 6-8 mL/kg; fraction of inspired oxygen 0.21-0.40, positive end-expiratory pressure 4-6 cmH2O) as central venous access and catheters were placed. Single-venous VV ECMO cannulation was performed with 13 Fr or 16 Fr bicaval dual-lumen catheters inserted into the right external jugular vein by placing the tip of the catheter approximately 6.5 cm down from the manubrium. Catheter placement was confirmed using TTE with Doppler. The cannula was then secured and connected to the porcine-primed ECMO circuit.
RESULTS: The TTE with Doppler images demonstrated proper placement of the bicaval dual-lumen catheter with further confirmation at the conclusion of the experiments on necropsy. There was no hemodynamic compromise with total gas exchange being achieved for the duration of the 4-hour experiment. For one hour of single-venous VV ECMO, mechanical ventilation was reduced to continuous positive pressure at 2 cmH2O with no change in gas exchange. The mean blood flow on VV ECMO was 0.76 ± 0.21 L/min.
CONCLUSIONS: Placement of a bi-caval dual lumen catheter for VV ECMO using anatomic landmarks in piglets was an efficient and effective method for research purposes with TTE Doppler imaging providing quick confirmation.
CLINICAL IMPLICATIONS: The development of animal models of single-venous VV ECMO will allow translational research to be performed to further advance our understanding of the physiological and molecular effects of this method of life support in humans, especially in children.
DISCLOSURE: The following authors have nothing to disclose: Don Hayes, Jr., Andrew Yates, Victoria Duffy, Louis Chicoine, Kathleen Nicol, Heidi Mansour, Patrick McConnell, Thomas Preston
No Product/Research Disclosure InformationThe Ohio State University, Columbus, OH