• Andrea Moscatelli, Silvia Buratti, Cesare Gregoretti, Elisabetta Lampugnani, Pietro Salvati, Maurizio Marasini, Elena Ribera, Ezio Fulcheri, and Pietro Tuo.
• Neonatal and Pediatric Intensive Care Unit, Department of Critical Care and Perinatal Medicine, Istituto Giannina Gaslini, Genoa - Italy.
• Int J Artif Organs. 2015 Sep 1; 38 (9): 517-21.

BackgroundVeno-venous extracorporeal membrane oxygenation (ECMO) is probably the preferable configuration to assist children with respiratory failure who do not respond to maximized conventional therapies. The single-vessel, double-lumen approach through the internal jugular vein is extremely advantageous, especially in infants, where femoral access presents limitations related to the small dimensions of the veins. In case of emergencies, ECMO might need to be started at the bedside, without the availability of fluoroscopic guidance. To our knowledge, a completely percutaneous approach has not been reported before in children younger than 1 year and weighing less than 5 kg.MethodsWe describe 3 cases of emergency bedside, percutaneous, bicaval double-lumen cannulation under real-time transthoracic ultrasound control in 2 neonates and 1 infant.ResultsIn our experience, this approach proved to be safe, effective and time saving, while minimizing bleeding from the cannula insertion site. Cannulation times, from decision making to the beginning of ECMO flow, were 30, 28, 25 minutes respectively, from patient 1 to 3. We do not report any cannula-related injury to vessels and heart structures.ConclusionsOur preliminary data suggest that, with the described precautions, percutaneous, echo-guided, bicaval double-lumen cannulation in neonates and infants could be effective and free from major complications. Further evaluation should be warranted in the neonatal population.

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