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"This study provides preliminary evidence that POCUS is more accurate than plain radiography for the evaluation of ECMO venous cannula position" Pawlowski et al (2021).

Neonatal ECMO catheter placement

Abstract:

Objective: To assess the ability of point-of-care ultrasound (POCUS) to identify venous cannula position in neonates on extracorporeal membrane oxygenation (ECMO) and compare with conventional imaging.

Study design: Retrospective review of 37 infants on ECMO with 51 POCUS studies between January 2017 and October 2019. Studies were reviewed for identification of venous cannula location and compared with plain radiography and echocardiography. Kappa statistic and predictive values were calculated.

Results: Venous cannula tip position was identified in 90% of POCUS studies. Fifty percent of the cannula tips were malpositioned. Plain radiography, the most commonly used method for evaluating tip position, showed poor agreement (57%) with POCUS (kappa 0.13). There was substantial agreement (89%) between echocardiography and POCUS (kappa 0.78).

Conclusion: This study provides preliminary evidence that POCUS is more accurate than plain radiography for the evaluation of ECMO venous cannula position. Adoption of this practice may prevent potentially catastrophic ECMO complications.

Reference:

Pawlowski TW, Stoller JZ, Rintoul NE, Hedrick HL, Quartermain MD, Fraga MV. Point-of-care ultrasound for the evaluation of venous cannula position in neonatal extracorporeal membrane oxygenation. J Perinatol. 2021 Apr 1. doi: 10.1038/s41372-021-00936-8. Epub ahead of print. PMID: 33795791.