Real-time localization of percutaneous venous drainage cannula tips for cardiopulmonary bypass: A prospective trial comparing intracavitary electrocardiography and transesophageal echocardiography
Maria Calabrese, Mauro Pittiruti, Gabriella Arlotta, Maria Enrica Antoniucci, Temistocle Taccheri, Filippo Corsi, Natalia Pavone, Federico Cammertoni, Maria Grandinetti, Denise Derrico, Maria Giuseppina Annetta, Andrea ScapigliatiIntroduction:
Accurate positioning of percutaneous venous drainage cannulas in the superior vena cava (SVC) is essential to ensure effective venous return during cardiopulmonary bypass (CPB), particularly in minimally invasive and re-operative cardiac surgery. Transesophageal echocardiography (TEE) is the reference standard for cannula tip localization but may not always be available or feasible. Intracavitary electrocardiography (IC-ECG) is an established technique for central venous catheter tip localization; however, its application to large-bore venous drainage cannulas used for CPB has not been previously investigated.
Methods:
This prospective single-center observational study enrolled 20 adult patients undergoing elective cardiac surgery requiring percutaneous SVC cannulation via the right internal jugular vein. IC-ECG signals were acquired in real-time through the cannula–introducer assembly during cannula advancement. Cannula tip position was simultaneously assessed using TEE as the reference standard. Mean P-wave amplitudes were measured at predefined anatomical locations: SVC, cavo-atrial junction (CAJ), and right atrium (RA), when feasible. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic accuracy of mean P-wave amplitude in identifying correct cannula tip positioning at the CAJ, compared with SVC and RA.
Results:
Interpretable IC-ECG signals were obtained in all patients. No adverse events were observed. Mean P-wave amplitude was significantly higher at the CAJ compared with the SVC and RA (7.4 vs 2.6 and 5.2 mm, respectively;
Conclusions:
IC-ECG is a feasible, safe, and accurate method for real-time localization of large-bore percutaneous venous drainage cannula tips, expanding its applicability within the field of vascular access.