Extracorporeal Membrane Oxygenation (ECMO) is a life-support system for patients with severe cardiac and respiratory failure. A key component of successful ECMO therapy is securing the large-bore cannulas that facilitate blood oxygenation and circulation. If these cannulas become dislodged, the patient may suffer catastrophic bleeding, air embolism, or circuit failure. Currently, there is no standardized fixation technique for ECMO cannulas, leading to variability in clinical practice.
This study investigates different cannula fixation methods, comparing traditional silk sutures with adhesive securement devices. The objective was to determine which method provides the most secure fixation, minimizing dislodgment risk while ensuring patient comfort and safety.
Methods
The research utilized an in vitro porcine skin model to mimic human tissue conditions. A 21F venous ECMO cannula was inserted using a modified Seldinger technique, and three different fixation methods were tested:
- Traditional Sutures – Three silk sutures were used to secure the cannula.
- CathGrip Adhesive Securement – A single suture combined with the CathGrip device.
- Hollister Adhesive Securement – A single suture with the Hollister device (sub-analysis).
To simulate cannula dislodgment, a uniaxial testing machine applied tensile forces at different dislodgment points (12.5 mm, 25 mm, and 50 mm). The researchers measured force resistance, stiffness, and total dislodgment energy absorption.
Results
The study analyzed 26 ECMO cannula fixations using sutures, 26 with CathGrip, and six with the Hollister device. Key findings include:
- Sutures exhibited high variability, with 27% rupturing at 50 mm dislodgment.
- CathGrip provided greater flexibility and stability in small displacements, requiring significantly more force to reach 12.5 mm dislodgment.
- At larger displacements (25 mm and 50 mm), both methods showed comparable fixation strength in terms of energy absorption.
- The Hollister adhesive device was less effective, requiring lower dislodgment forces at 25 mm and 50 mm compared to CathGrip.
Discussion
The study suggests that adhesive securement methods like CathGrip could serve as a viable alternative to traditional sutures. While sutures offer secure fixation, they pose risks such as tearing, skin irritation, and increased infection potential. Adhesive devices provide additional flexibility and resistance to micro-movements, which may reduce cannula-related complications.
Micro-movements of ECMO cannulas have been linked to an increased risk of infection and thrombosis. CathGrip demonstrated greater stiffness and dislodgment resistance in the 0–5 mm range, making it a promising solution for minimizing unwanted movement. This is particularly relevant for patients undergoing ECMO therapy with early mobilization strategies.
However, while adhesive devices may offer comparable or superior fixation to sutures, further clinical trials are needed to confirm these findings in real-world patient scenarios.
Conclusion
CathGrip adhesive securement demonstrated promising results in ECMO cannula fixation, offering benefits such as increased flexibility, superior resistance to micro-movements, and comparable overall fixation strength to sutures. These findings suggest that adhesive anchoring may be an effective alternative for securing ECMO cannulas, potentially reducing dislodgment risk and improving patient comfort. Future studies should assess clinical outcomes and long-term performance of adhesive securement in ECMO patients.
Study Ranking = 4 (High Quality) This study used a controlled in vitro model with rigorous testing methods. However, it lacks real-world clinical trials, which are necessary to confirm its findings in human patients.
