5: Single centre experience of Neonatal multisite VV ECMO - Intensivist led percutaneous cannulation with ultrasound guidance at the bedside.

Introduction: Neonates with respiratory failure can be supported by Veno-Arterial (VA) or Veno-Venous (VV) ECMO. VV ECMO in neonates appears to result in fewer neurological complications than VA. Neonatal multi-site VV ECMO; accessing the right internal jugular vein (RIJ) and returning to the femoral vein (FV), has been reported to be safe, and potentially more favourable than the double lumen VV (DLVV) cannula which is associated with recognised significant complications. Both surgical and percutaneous techniques have been described to cannulate his patient population3. We describe our technique and experience of neonatal percutaneous VV ECMO multisite cannulation within our institution in this retrospective observational study. Results: Since 2023, 5 neonates have been cannulated percutaneously by intensivists at the bedside for VV multisite ECMO. Ultrasound is used prior to and throughout cannulation, to assess cardiac anatomy and function, confirm venous patency/size, to ensure the correct wire location prior to dilating and to optimise cannula positioning. 3 patients were cannulated directly with multisite VV ECMO. 2 patients were managed initially with peripheral VA + VVA ECMO (cannulated with ‘hybrid’ approach – percutaneous venous access, and surgical arterial access) before a subsequent percutaneous configuration change to VV multisite to continue ECMO support. All VV multisite configurations drained with a 10F cannula in the RIJ (except 1 where the subclavian vein was cannulated with an 8F), and all return was through an 8F cannula sited in the FV (4 right sided, 1 left sided). There were no bleeding or mechanical complications during any of the cannulations. Conclusion: Percutaneous multisite VV ECMO cannulation at the bedside is a safe and effective method for neonatal VV ECMO support.