33: Better Secure Than Sorry: Developing Evidence Based Best Practice Guidelines for ECMO Cannula Securement

Cannula dislodgement is one of the gravest complications of Extracorporeal Membrane Oxygenation (ECMO) that can easily be prevented. After experiencing three near-miss events over a two-year period, we acknowledged the need for change and utilized a rapid review approach to develop and implement a new securement policy to prevent future occurrences. We conducted a comprehensive literature search and found insufficient evidence to support best practice guidelines for the prevention of cannula complications. The barrier of “more research is needed on this topic” led us to take a closer look at the data we’ve collected on over 200 patients on mechanical circulatory support and develop our own best practice guidelines. Our new policy requires several anchor points using 3-5 #5 ethibond sutures as well as one catheter securement device per cannula/circuit tubing. Securement integrity is assessed daily along with every ECMO cannula dressing change to confirm securement at the insertion site is intact at the skin and the cannula/circuit tubing. Cannula position is assessed daily with x-ray and all suture securement is replaced at 30 days on ECMO, or sooner if any sutures are found to no longer be intact. With this new protocol we have not experienced any near misses related to cannula dislodgement. We went on to build a survey that was sent to 60 ELSO platinum and gold centers of excellence within the United States and look forward to presenting our findings at ELSO with the goal of stimulating discussion on ECMO cannula securement. .