Pichoy Danial1, David Hajage2, Lee S Nguyen1, Ciro Mastroianni1, Pierre Demondion1, Matthieu Schmidt3, Adrien Bouglé4, Julien Amour4, Pascal Leprince1, Alain Combes3, Guillaume Lebreton5. 1. Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France. 2. Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique Et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Paris, France. 3. Medical Intensive Care Unit, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France. 4. Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France. 5. Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France. guillaume.lebreton@aphp.fr.
Abstract
PURPOSE: Femoral artery surgical cannulation is the reference for venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults. However, the less invasive percutaneous approach has been associated with lower rates of complications. This retrospective study compared complication rates and overall survival in a large series of patients who received surgical or percutaneous peripheral VA-ECMO. METHODS: All consecutive patients implanted with VA-ECMO between January 2015 and December 2017 in a high ECMO-volume university hospital were included. Surgical cannulation was the only approach until late 2016 after which the percutaneous approach became the first line strategy. Propensity score framework analyzes were used to compare outcomes of percutaneous and surgical groups while controlling for confounders. RESULTS: Among the 814 patients who received VA-ECMO (485 surgical and 329 percutaneous), propensity-score matching selected 266 unique pairs of patients with similar characteristics. Percutaneous cannulation was associated with fewer local infections (16.5% versus 27.8%, p = 0.001), similar rates of limb ischemia (8.6% versus 12.4%, p = 0.347) and sensory-motor complications (2.6% versus 2.3%, p = 0.779) and improved 30-day survival (63.8% versus 56.3%, p = 0.034). However, more vascular complications following decannulation (14.7% versus 3.4%, p < 0.001), mainly persistent bleeding requiring surgical revision (9.4% vs. 1.5%, p < 0.001), occurred after percutaneous cannulation. CONCLUSIONS: Compared to the surgical approach, percutaneous cannulation for peripheral VA-ECMO was associated with fewer local infections, similar rates of ischemia and sensory-motor complications and improved 30-day survival. The higher rate of vascular complications following decannulation suggests that improvements in cannula removal techniques are needed to further improve patients' outcomes after percutaneous cannulation.
PURPOSE: Femoral artery surgical cannulation is the reference for venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults. However, the less invasive percutaneous approach has been associated with lower rates of complications. This retrospective study compared complication rates and overall survival in a large series of patients who received surgical or percutaneous peripheral VA-ECMO. METHODS: All consecutive patients implanted with VA-ECMO between January 2015 and December 2017 in a high ECMO-volume university hospital were included. Surgical cannulation was the only approach until late 2016 after which the percutaneous approach became the first line strategy. Propensity score framework analyzes were used to compare outcomes of percutaneous and surgical groups while controlling for confounders. RESULTS: Among the 814 patients who received VA-ECMO (485 surgical and 329 percutaneous), propensity-score matching selected 266 unique pairs of patients with similar characteristics. Percutaneous cannulation was associated with fewer local infections (16.5% versus 27.8%, p = 0.001), similar rates of limb ischemia (8.6% versus 12.4%, p = 0.347) and sensory-motor complications (2.6% versus 2.3%, p = 0.779) and improved 30-day survival (63.8% versus 56.3%, p = 0.034). However, more vascular complications following decannulation (14.7% versus 3.4%, p < 0.001), mainly persistent bleeding requiring surgical revision (9.4% vs. 1.5%, p < 0.001), occurred after percutaneous cannulation. CONCLUSIONS: Compared to the surgical approach, percutaneous cannulation for peripheral VA-ECMO was associated with fewer local infections, similar rates of ischemia and sensory-motor complications and improved 30-day survival. The higher rate of vascular complications following decannulation suggests that improvements in cannula removal techniques are needed to further improve patients' outcomes after percutaneous cannulation.
Authors: N Yoshimura; K Ataka; K Nakagiri; T Azami; M Yoshida; C Yamashita; M Okada Journal: J Cardiovasc Surg (Torino) Date: 1996-12 Impact factor: 1.888
Authors: Laura Ruggeri; Martina Evangelista; Filippo Consolo; Andrea Montisci; Alberto Zangrillo; Federico Pappalardo Journal: Intensive Care Med Date: 2016-11-30 Impact factor: 17.440
Authors: Alain Combes; Dan Brodie; Yih-Sharng Chen; Eddy Fan; José P S Henriques; Carol Hodgson; Philipp M Lepper; Pascal Leprince; Kunihiko Maekawa; Thomas Muller; Sebastian Nuding; Dagmar M Ouweneel; Antoine Roch; Matthieu Schmidt; Hiroo Takayama; Alain Vuylsteke; Karl Werdan; Laurent Papazian Journal: Intensive Care Med Date: 2017-05-03 Impact factor: 17.440
Authors: Hiroo Takayama; Elissa Landes; Lauren Truby; Kevin Fujita; Ajay J Kirtane; Linda Mongero; Melana Yuzefpolskaya; Paolo C Colombo; Ulrich P Jorde; Paul A Kurlansky; Koji Takeda; Yoshifumi Naka Journal: J Thorac Cardiovasc Surg Date: 2015-02-07 Impact factor: 5.209
Authors: Nicolas Majunke; Norman Mangner; Axel Linke; Enno Boudriot; Sandra Erbs; Franziska Tietz; Sabrina Wolff; Stephan Schürer; Gerhard Schuler; Marcus Sandri Journal: J Invasive Cardiol Date: 2016-10 Impact factor: 2.022
Authors: Mehmet Cakici; Evren Ozcinar; Cagdas Baran; Ahmet Onat Bermede; Mehmet Cahit Sarıcaoglu; Mustafa Bahadır Inan; Mustafa Serkan Durdu; Atilla Aral; Mustafa Sirlak; Ahmet Ruchan Akar Journal: Perfusion Date: 2016-12-01 Impact factor: 1.972
Authors: Marc Pineton de Chambrun; Nicolas Bréchot; Guillaume Lebreton; Matthieu Schmidt; Guillaume Hekimian; Pierre Demondion; Jean-Louis Trouillet; Pascal Leprince; Jean Chastre; Alain Combes; Charles-Edouard Luyt Journal: Intensive Care Med Date: 2016-09-28 Impact factor: 17.440
Authors: Robertas Samalavičius; Lina Puodžiukaitė; Vytautas Abraitis; Ieva Norkienė; Nadežda Ščupakova; Justina Pekarskienė; Aleksejus Zorinas; Kęstutis Ručinskas; Pranas Šerpytis Journal: Acta Med Litu Date: 2019
Authors: Jeffrey DellaVolpe; Ryan P Barbaro; Jeremy W Cannon; Eddy Fan; Wendy R Greene; Kyle J Gunnerson; Lena M Napolitano; Ace Ovil; Jeremy C Pamplin; Matthieu Schmidt; Lauren R Sorce; Daniel Brodie Journal: Crit Care Med Date: 2020-06 Impact factor: 7.598
Authors: Demetris Yannopoulos; Jason Bartos; Ganesh Raveendran; Emily Walser; John Connett; Thomas A Murray; Gary Collins; Lin Zhang; Rajat Kalra; Marinos Kosmopoulos; Ranjit John; Andrew Shaffer; R J Frascone; Keith Wesley; Marc Conterato; Michelle Biros; Jakub Tolar; Tom P Aufderheide Journal: Lancet Date: 2020-11-13 Impact factor: 79.321
Authors: Darryl Abrams; Giacomo Grasselli; Matthieu Schmidt; Thomas Mueller; Daniel Brodie Journal: Intensive Care Med Date: 2019-11-25 Impact factor: 41.787