OBJECTIVES: To facilitate venoarterial extracorporeal membrane oxygenation (ECMO) insertion for cardiogenic shock, we recently adopted a strategy of using a 15F arterial cannula in all patients, rather than 1 designed to maximize flow. We aimed to compare the clinical outcomes of these 2 strategies. METHODS: In this retrospective study, 101 consecutive patients supported with ECMO via femoral cannulation between March 2007 and March 2013 were divided into 2 groups: Group L (17F-24F arterial cannula to accommodate full flow [ie, cardiac index of 2.5 L/m(2)/min]; n = 51) and Group S (15F arterial cannula; n = 50). The primary outcomes of interest were patients' overall status at 24 hours of support and cannulation-related adverse events. RESULTS: There were no significant differences in patient demographics, etiology of cardiogenic shock, or severity of illness before ECMO initiation between the 2 groups. Group L had significantly higher ECMO flow than Group S (flow index at 24 hours: 2.2 ± 0.7 vs 1.7 ± 0.3 L/m(2)/min; P < .001). However, there was no significant difference in use of vasoactive medication/hemodynamic parameters/laboratory parameters. Group L had higher incidence of cannulation-related adverse events (35% vs 22% in Group S [P = .14]), particularly in cannulation site bleeding (28% vs 10% [P = .03]). Thirty-day survival was 55% in Group L versus 52% in Group S (P = .77). Bleeding complication occurred in 53% in Group L versus 32% in Group S (P = .03). CONCLUSIONS: Compared with the use of larger cannulas, ECMO with a 15F arterial cannula appears to provide comparable clinical support with reduced bleeding complications.
OBJECTIVES: To facilitate venoarterial extracorporeal membrane oxygenation (ECMO) insertion for cardiogenic shock, we recently adopted a strategy of using a 15F arterial cannula in all patients, rather than 1 designed to maximize flow. We aimed to compare the clinical outcomes of these 2 strategies. METHODS: In this retrospective study, 101 consecutive patients supported with ECMO via femoral cannulation between March 2007 and March 2013 were divided into 2 groups: Group L (17F-24F arterial cannula to accommodate full flow [ie, cardiac index of 2.5 L/m(2)/min]; n = 51) and Group S (15F arterial cannula; n = 50). The primary outcomes of interest were patients' overall status at 24 hours of support and cannulation-related adverse events. RESULTS: There were no significant differences in patient demographics, etiology of cardiogenic shock, or severity of illness before ECMO initiation between the 2 groups. Group L had significantly higher ECMO flow than Group S (flow index at 24 hours: 2.2 ± 0.7 vs 1.7 ± 0.3 L/m(2)/min; P < .001). However, there was no significant difference in use of vasoactive medication/hemodynamic parameters/laboratory parameters. Group L had higher incidence of cannulation-related adverse events (35% vs 22% in Group S [P = .14]), particularly in cannulation site bleeding (28% vs 10% [P = .03]). Thirty-day survival was 55% in Group L versus 52% in Group S (P = .77). Bleeding complication occurred in 53% in Group L versus 32% in Group S (P = .03). CONCLUSIONS: Compared with the use of larger cannulas, ECMO with a 15F arterial cannula appears to provide comparable clinical support with reduced bleeding complications.
Authors: Martin Geyer; Bernhard Gohrbandt; Ingo Sagoschen; Thomas Hartmann; Felix Post; Christian-Friedrich Vahl; Thomas Münzel Journal: J Artif Organs Date: 2017-11-09 Impact factor: 1.731
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Authors: Darryl Abrams; A Reshad Garan; Akram Abdelbary; Matthew Bacchetta; Robert H Bartlett; James Beck; Jan Belohlavek; Yih-Sharng Chen; Eddy Fan; Niall D Ferguson; Jo-Anne Fowles; John Fraser; Michelle Gong; Ibrahim F Hassan; Carol Hodgson; Xiaotong Hou; Katarzyna Hryniewicz; Shingo Ichiba; William A Jakobleff; Roberto Lorusso; Graeme MacLaren; Shay McGuinness; Thomas Mueller; Pauline K Park; Giles Peek; Vin Pellegrino; Susanna Price; Erika B Rosenzweig; Tetsuya Sakamoto; Leonardo Salazar; Matthieu Schmidt; Arthur S Slutsky; Christian Spaulding; Hiroo Takayama; Koji Takeda; Alain Vuylsteke; Alain Combes; Daniel Brodie Journal: Intensive Care Med Date: 2018-02-15 Impact factor: 17.440
Authors: Sarah B Cairo; Mary Arbuthnot; Laura Boomer; Michael W Dingeldein; Alexander Feliz; Samir Gadepalli; Christopher R Newton; Pramod Puligandla; Robert Ricca; Peter Rycus; Adam M Vogel; Guan Yu; Ziqiang Chen; David H Rothstein Journal: Pediatr Crit Care Med Date: 2018-10 Impact factor: 3.624