Iliohypogastric and Ilioinguinal Nerve Block for Awake ECPella Cannulation in Pediatric Patients With Nonpostcardiotomy Cardiogenic Shock

In pediatric cardiogenic shock, endotracheal intubation may carry a high risk of cardiac arrest during anesthesia induction. This single-center retrospective case series (2020-2025) evaluated the feasibility, safety, and outcomes of ultrasound (US)-guided ilioinguinal-iliohypogastric (IhIG) nerve blocks (0.05-0.1 ml/kg of 0.25% ropivacaine) under light sedation to facilitate awake venoarterial extracorporeal membrane oxygenation and Impella (ECPella) surgical cannulation. Five adolescents (median age: 13 years, range: 7-17; median weight: 45 kg, range: 21-58) with nonpostcardiotomy cardiogenic shock underwent successful IhIG block placement in the pediatric intensive care unit by anesthesia-trained intensivists, followed by surgical cannulation in the catheterization laboratory. Intubation and mechanical ventilation were avoided during initial cannulation and throughout ECPella duration. Three patients required a modified chimney Y-graft for cannula placement, and two experienced local surgical bleeding. All five patients survived to hospital discharge, with three achieving direct biventricular recovery. Based on these preliminary data, US-guided IhIG nerve block seems a feasible and safe strategy for awake ECPella cannulation in selected pediatric patients, successfully avoiding high-risk invasive ventilation and general anesthesia.