Staying in Place: In Vitro Comparison of Extracorporeal Membrane Oxygenation Cannula Fixation for Dislodgment Prevention

Abstract

Background/Objectives: Secure large-bore cannula insertion is critical for effective extracorporeal membrane oxygenation (ECMO), as inadequate fixation can lead to complications such as infection, dislodgment, and life-threatening events. With inconsistent guidelines for ECMO line management, this study compares the effectiveness of traditional suture fixation to an adhesive securement method in the prevention of ECMO cannula dislodgment using an in vitro model. Methods: Porcine skin and muscle tissue sections were prepared and mounted in a custom holder. A 21F venous ECMO cannula was inserted using a modified Seldinger technique. Three fixation methods were randomly compared: (1) three silk sutures, and (2a) one silk suture with a CathGrip adhesive anchoring device. In addition, a sub-analysis was performed using (2b) the Hollister adhesive anchoring device. A uniaxial testing machine simulated 50 mm cannula dislodgment, measuring tensile forces at 12.5, 25, and 50 mm dislodgment points. Results: A total of 26 ECMO cannula fixations using sutures, 26 with adhesive CathGrip, six with a Hollister device, and three controls were tested across six porcine samples. Sutures demonstrated greater variability in force at maximum dislocation, with 27% rupturing at 50 mm. In contrast, CathGrip provided greater flexibility without tearing. The adhesive exhibited higher stiffness (2.38 N/mm vs. 2.09 N/mm, p < 0.001) and dislodgment energy (0.034 J vs. 0.032 J, p = 0.002) in the 0-5 mm range, while sutures showed greater stiffness in the 5-50 mm range (1.42 N/mm vs. 1.18 N/mm, p < 0.001). At larger displacements (25 mm and 50 mm) and in total energy absorption, no statistically significant differences were observed (p = 0.57). In a sub-analysis, the six fixations using the Hollister device exhibited higher variability and significantly lower dislodgment forces at 25 mm (p = 0.033) and 50 mm (p = 0.004) compared to the CathGrip device. Conclusions: This study suggests that adhesive anchoring methods, such as CathGrip, may provide comparable or potentially superior fixation strength to sutures for ECMO cannula stabilization under controlled conditions. However, further research, including clinical trials, is necessary to confirm these findings, evaluate long-term performance, and explore the implications for dislodgment risk and infection prevention in clinical practice.

Keywords: adhesive anchoring; cannula dislodgment; cannula fixation; cannula-related infection; extracorporeal membrane oxygenation; securement.

Figure 1

Techniques tested for ECMO cannula fixation: (A) standard (three sutures); (B) adhesive anchoring device (CathGrip) with one suture at the cannula insertion site.

Figure 2

(A) Test specimen with implanted ECMO Cannula and adhesive fixation (front view); (B) front, side, and bottom views of the testing frame; (C) side view of a test specimen with implanted ECMO cannula and suture fixation; (D) side view of the testing frame.

Figure 3

Individual and mean load per dislodgment distance for sutures (A) and the CathGrip adhesive anchoring device (B).

Figure 4

Depiction of standardized suture fixation with three sutures at 50 mm dislodgment of the ECMO cannula (A); at 0 mm dislodgment (B); and after adhesive anchoring device (CathGrip) fixation at 50 mm ECMO cannula dislodgment (C) as well as 0 mm dislodgment (D).

Figure 5

Statistical comparison of extraction load at 12.5 mm, 25 mm, and 50 mm cannula dislodgment, stratified by sutures (red) and the adhesive anchoring device (blue). n.s. (not statistically significant).