Point-of-care ultrasound for the evaluation of venous cannula position in neonatal extracorporeal membrane oxygenation

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.

Automated summary

The study suggests that POCUS is more accurate in evaluating ECMO venous cannula position than plain radiography, and there is substantial agreement between POCUS and echocardiography, indicating that POCUS may be a better method for assessing ECMO venous cannula position.