Securing ECMO Cannulae: Is It Time for Evidence-Based Guidelines?

Effective securement of extracorporeal membrane oxygenation (ECMO) cannulae is essential for preventing migration, dislodgement, and infection—events that can have life-threatening consequences. This point prevalence study, conducted across Australia and New Zealand, sheds light on current cannula dressing and securement practices and highlights the urgent need for ECMO-specific clinical guidelines.

Study Overview

Over 12 months, data were collected from 127 ECMO patients (100 adults, 27 paediatric/neonatal) at 11 centres in Australia and New Zealand. The study assessed securement methods, dressing types, and adherence to local guidelines for both peripheral and central ECMO cannulae and tubing.

Key Findings

1. Variation in Practice: Dressing and securement methods varied significantly between centres and across age groups, with low adherence to local guidelines—only 12% of insertion sites and 6% of circuit tubings were compliant.
2. Peripheral Cannulae: Transparent semipermeable dressings were common, but CHG dressings were rarely used (<10%). Sutures were more commonly used in neonates/paediatrics than adults.
3. Circuit Tubing: Most tubing was secured with sutureless devices, but fixation methods varied. Two fixation points were most common across all groups.
4. Central Cannulae: These were often secured with sutures and had a wider variety of dressing materials, including Gore-Tex® membranes in paediatric patients.
5. Guideline Gaps: Despite existing general recommendations, the lack of ECMO-specific guidance limits consistency and quality of care.

Conclusion

This is the first study to map real-world ECMO cannula securement practices in Australia and New Zealand. The findings reveal widespread variation and low compliance with existing policies, underscoring the need for ECMO-specific, evidence-based clinical practice guidelines. Effective securement is a patient safety priority—future research and standardisation are essential to reduce complications and improve outcomes.

Read more:https://www.australiancriticalcare.com/article/S1036-7314(25)00128-6/fulltext 

Authors: Amanda Corley, India Pearse, Jayshree D. Lavana, Abhilasha Ahuja, Chris M. Anstey, Emma Haisz, Rachael Parke, Mandy Tallott, Vincent A. Pellegrino, Hergen Buscher, John F. Fraser, on behalf of the ECMO Point Prevalence Study Investigators