Short 🧵on ECMO Dilators...
Highlights
- Short 🧵on ECMO dilators now that I've managed to piece together a whole set.
Shown are Maquet dilators (left) and Opus dilators (right) with a 7 Fr central line in the middle for size comparison.
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- Quick review:
We're mostly a VV center (now with Platinum designation). We use a 2-cannula setup in most cases (we don't use the dual-lumen ones, like the Avalon).
Our most common configuration is a RIJ 19 Fr 'return' cannula and a 25 Fr R femoral 'drainage' cannula.
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- These are the Maquet dilators.
Once the wire is in, we start with the 10 Fr dilator on the left and keep increasing in size, with no more than a 4 Fr difference in between passes.
So for a 25 Fr cannula the sequence is 10-12-16-20-24-26 (partially) - then the cannula.
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- These are the Opus dilators.
They are similar, except for being a little stiffer, and they also have a ridge at the end to help in passing them. The ridge is a fairly minor difference IMO.
Again, we pass sequential dilators as needed depending on cannula size.
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- Here you can see that the Maquet dilator is a little floppier than the Opus dilator.
Honestly, I don't notice much of a difference but theoretically the Maquet might be harder to use in deeper groins, but the Opus might lead to more vessel injury. Speculative though.
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- There are also Sorin dilators (shown in the package).
These are shorter and stiffer than the others, so can be used in difficult obese groins, and also sometimes to salvage a bent wire situation. They only go up to 24 Fr, however.
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- Just to show the size of these things, this is a photo of a 26 Fr dilator (the largest one we usually pass) next to a typical 7 Fr central line.
Believe it or not, when the cannula comes out, it still usually stops bleeding with pressure and a pursestring suture at the skin.
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- With serial dilation, we can see that the defect in the orange fits nicely around the 26 FR dilator. The 25 Fr cannula will go in easily, and there will also be a pursestring suture for both security and hemostasis.
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