Percutaneous versus surgical cannulation for femoro-femoral VA-ECMO in patients with cardiogenic shock: Results from the Extracorporeal Life Support Organization Registry.

Abstract

PURPOSE:

Percutaneous cannulation is increasingly used for veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, there is limited evidence about the benefit of this approach compared with conventional surgical cannulation. By using a large international database, this study was designed to compare in-hospital outcomes in cardiac shock patients who received femoro-femoral VA-ECMO with percutaneous versus surgical cannulation.

METHODS:

Adults with refractory cardiogenic shock treated with percutaneous (percutaneous group) or surgical (surgical group) femoro-femoral VA-ECMO between January 2008 and December 2019 were extracted from the international Extracorporeal Life Support Organization registry. The primary outcome was in-hospital mortality. Multivariable logistic regression analyses were performed to assess the association between percutaneous cannulation and in-hospital outcomes.

RESULTS:

Among 12,592 patients meeting study inclusion, 9,249 (73%) underwent percutaneous cannulation. The proportion of patients undergoing percutaneous cannulation increased from 32% to 84% over the study period (p < 0.01 for trend). In-hospital mortality (53% vs 58%; p < 0.01), cannulation site bleeding (19% vs 22%; p < 0.01), and systemic infection (8% vs 15%; p < 0.01) occurred less frequently in the percutaneous group compared to the surgical group. In adjusted analyses, percutaneous cannulation was independently associated with lower rates of in-hospital mortality (odds ratio [OR] 0.76; 95% CI 0.70-0.84; p < 0.01), cannulation site bleeding (OR 0.70; 95% CI 0.60-0.80; p < 0.01) and systemic infection (OR, 0.63; 95% CI 0.54-0.74; p < 0.01). Severe limb ischemia was more frequently observed in the percutaneous group (5% vs 3%; p < 0.01). However, this association was not significant in adjusted analysis (OR 1.28; 95% CI 0.93-1.62; p = 0.15).

CONCLUSIONS:

Compared with surgical cannulation, percutaneous cannulation was independently associated with lower in-hospital mortality and fewer complications.

• Authors: Liangshan Wang, Feng Yang, Shuai Zhang, Chenglong Li, Zhongtao Du, Peter Rycus, Joseph E Tonna, Peta Alexander, Roberto Lorusso, Eddy Fan, Mark Ogino, Daniel Brodie, Alain Combes, Yih-Sharng Chen, Haibo Qiu, Zhiyong Peng, John F Fraser, Juanjuan Shao, Ming Jia, Hong Wang, Xiaotong Hou
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 41 Issue 4 Pg. 470-481 (04 2022) ISSN: 1557-3117 [Electronic] United States
• PMID: 35125287 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Catheterization
• Extracorporeal Membrane Oxygenation (methods)
• Humans
• Registries
• Retrospective Studies
• Shock, Cardiogenic (etiology, surgery)