Extracorporeal membrane oxygenation (ECMO), an invasive mechanical therapy, provides cardio-respiratory support to critically ill patients when maximal conventional support has failed. ECMO is delivered via large-bore cannulae which must be effectively secured to avoid complications including cannula migration, dislodgement and accidental decannulation. Growing evidence suggests tissue adhesive (TA) may be a practical and safe method to secure vascular access devices, but little evidence exists pertaining to securement of ECMO cannulae. The aim of this study was to determine the safety and efficacy of two TA formulations (2-octyl cyanoacrylate and n-butyl-2-octyl cyanoacrylate) for use in peripherally inserted ECMO cannula securement, and compare TA securement to ‘standard’ securement methods. This in vitro project assessed: (1) the tensile strength and flexibility of TA formulations compared to ‘standard’ ECMO cannula securement using a porcine skin model, and (2) the chemical resistance of the polyurethane ECMO cannulae to TA. An Instron 5567 Universal Testing System was used for strength testing in both experiments. Securement with sutures and n-butyl-2-octyl cyanoacrylate both significantly increased the force required to dislodge the cannula compared to a transparent polyurethane dressing (p = 0.006 and p = 0.003, respectively) and 2-octyl cyanoacrylate (p = 0.023 and p = 0.013, respectively). Suture securement provided increased flexibility compared to TA securement (p < 0.0001), and there was no statistically significant difference in flexibility between 2-octyl cyanoacrylate and n-butyl-2-octyl cyanoacrylate (p = 0.774). The resistance strength of cannula polyurethane was not weakened after exposure to either TA formulation after 60 min compared to control. Tissue adhesive appears to be a promising adjunct method of ECMO cannula insertion site securement. Tissue adhesive securement with n-butyl-2-octyl cyanoacrylate may provide comparable securement strength to a single polypropylene drain stitch, and, when used as an adjunct securement method, may minimise the risks associated with suture securement. However, further clinical research is still needed in this area.

中文翻译：

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体外膜氧合套管固定用氰基丙烯酸酯组织粘合剂和缝合线的体外测试

体外膜肺氧合 (ECMO) 是一种侵入性机械疗法，可在最大常规支持失败时为危重患者提供心肺支持。ECMO 通过大口径套管输送，必须有效固定大口径套管，以避免出现套管移位、移位和意外拔管等并发症。越来越多的证据表明组织粘合剂 (TA) 可能是固定血管通路装置的一种实用且安全的方法，但关于固定 ECMO 套管的证据很少。本研究的目的是确定用于外周插入式 ECMO 插管固定的两种 TA 制剂（氰基丙烯酸 2-辛酯和氰基丙烯酸正丁酯）的安全性和有效性，并将 TA 固定与“标准”固定方法进行比较. 该体外项目评估了：(1) TA 制剂的拉伸强度和柔韧性与使用猪皮肤模型的“标准”ECMO 套管固定相比，以及 (2) 聚氨酯 ECMO 套管对 TA 的耐化学性。Instron 5567 通用测试系统用于两个实验中的强度测试。与透明聚氨酯敷料（分别为 p = 0.006 和 p = 0.003）和氰基丙烯酸 2-辛酯（p = 0.023 和 p = 0.013，分别）。与 TA 固定相比，缝合固定提供了更高的柔韧性（p < 0.0001），并且氰基丙烯酸 2-辛酯和氰基丙烯酸正丁酯 2-辛酯之间的柔韧性没有统计学上的显着差异（p = 0.774）。与对照相比，在暴露于任一 TA 制剂 60 分钟后，套管聚氨酯的抵抗强度并未减弱。组织粘合剂似乎是一种很有前途的 ECMO 插管插入部位固定的辅助方法。使用氰基丙烯酸正丁酯 2-辛酯进行组织粘合剂固定可以提供与单个聚丙烯引流针迹相当的固定强度，并且当用作辅助固定方法时，可以最大限度地降低与缝合线固定相关的风险。然而，该领域仍需要进一步的临床研究。使用氰基丙烯酸正丁酯 2-辛酯进行组织粘合剂固定可以提供与单个聚丙烯引流针迹相当的固定强度，并且当用作辅助固定方法时，可以最大限度地降低与缝合线固定相关的风险。然而，该领域仍需要进一步的临床研究。使用氰基丙烯酸正丁酯 2-辛酯进行组织粘合剂固定可以提供与单个聚丙烯引流针迹相当的固定强度，并且当用作辅助固定方法时，可以最大限度地降低与缝合线固定相关的风险。然而，该领域仍需要进一步的临床研究。