Frank Bidar1, Aymeric Lancelot2, Guillaume Lebreton3, Marc Pineton de Chambrun1, Matthieu Schmidt4, Guillaume Hékimian1, Charles Juvin3, Nicolas Bréchot1, Thibaut Schoell3, Pascal Leprince3, Alain Combes4, Adrien Bouglé2, Charles-Edouard Luyt5. 1. Service de Médecine Intensive Réanimation. 2. Département d'Anesthésie-Réanimation. 3. Service de Chirurgie Cardiaque, Thoracique et Vasculaire, Institut de Cardiologie, Hôpital Pitié Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France. 4. Service de Médecine Intensive Réanimation; INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France. 5. Service de Médecine Intensive Réanimation; INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France. Electronic address: charles-edouard.luyt@aphp.fr.
Abstract
BACKGROUND: Although venous thrombosis after venovenous-extracorporeal membrane oxygenation (ECMO) is well described, vascular complications occurring after venoarterial ECMO (VA-ECMO) removal have not yet been thoroughly described. Our aim was to evaluate the frequency of vascular (arterial and venous) complications after VA-ECMO removal and try to identify the risk factors associated with them. METHODS: Retrospective analysis of data prospectively collected in 2 intensive care units was performed. Consecutive patients successfully weaned off VA-ECMO during year 1 were screened for cannula-associated deep vein thrombosis (CaDVT) or arterial complications (arterial thrombosis/stenosis) using Doppler ultrasonography. RESULTS: From November 2018 to November 2019, a total of 107 patients with a median (interquartile range [IQR]) age of 54 (42-63) years and a median (IQR) ECMO support duration of 8 (2-5) days were successfully weaned off VA-ECMO and included. CaDVT occurred in 44 patients (41%), and arterial complications occurred in 15 (14%) (9 acute leg ischemia, 1 arteriovenous femoral fistula, and 5 late femoral stenosis). Multivariable analysis retained longer duration of ECMO support (odds ratio [OR]: 1.12 per day; 95% CI: 1.02-1.22) and infection occurring on ECMO (OR: 3.03; 95% CI: 1.14-8.03) as independent risk factors for CaDVT, whereas older age (OR: 0.97 per year; 95% CI: 0.94-0.99) and previous anti-coagulation use (OR: 0.21; 95% CI: 0.06-0.68) were protective factors for CaDVT. No risk factors for arterial complications were identified. CONCLUSIONS: In patients requiring VA-ECMO support, vascular complications occurred frequently after its removal, especially CaDVT. Arterial complications, either early leg ischemia or late arterial stenosis, were observed less often. Strategies aimed at preventing CaDVT after VA-ECMO remain to be determined.
BACKGROUND: Although venous thrombosis after venovenous-extracorporeal membrane oxygenation (ECMO) is well described, vascular complications occurring after venoarterial ECMO (VA-ECMO) removal have not yet been thoroughly described. Our aim was to evaluate the frequency of vascular (arterial and venous) complications after VA-ECMO removal and try to identify the risk factors associated with them. METHODS: Retrospective analysis of data prospectively collected in 2 intensive care units was performed. Consecutive patients successfully weaned off VA-ECMO during year 1 were screened for cannula-associated deep vein thrombosis (CaDVT) or arterial complications (arterial thrombosis/stenosis) using Doppler ultrasonography. RESULTS: From November 2018 to November 2019, a total of 107 patients with a median (interquartile range [IQR]) age of 54 (42-63) years and a median (IQR) ECMO support duration of 8 (2-5) days were successfully weaned off VA-ECMO and included. CaDVT occurred in 44 patients (41%), and arterial complications occurred in 15 (14%) (9 acute leg ischemia, 1 arteriovenous femoral fistula, and 5 late femoral stenosis). Multivariable analysis retained longer duration of ECMO support (odds ratio [OR]: 1.12 per day; 95% CI: 1.02-1.22) and infection occurring on ECMO (OR: 3.03; 95% CI: 1.14-8.03) as independent risk factors for CaDVT, whereas older age (OR: 0.97 per year; 95% CI: 0.94-0.99) and previous anti-coagulation use (OR: 0.21; 95% CI: 0.06-0.68) were protective factors for CaDVT. No risk factors for arterial complications were identified. CONCLUSIONS: In patients requiring VA-ECMO support, vascular complications occurred frequently after its removal, especially CaDVT. Arterial complications, either early leg ischemia or late arterial stenosis, were observed less often. Strategies aimed at preventing CaDVT after VA-ECMO remain to be determined.
Authors: Jose I Nunez; Andre F Gosling; Brian O'Gara; Kevin F Kennedy; Peter Rycus; Darryl Abrams; Daniel Brodie; Shahzad Shaefi; A Reshad Garan; E Wilson Grandin Journal: Intensive Care Med Date: 2021-12-18 Impact factor: 41.787
Authors: Christoph Fisser; Corina Armbrüster; Clemens Wiest; Alois Philipp; Maik Foltan; Dirk Lunz; Karin Pfister; Roland Schneckenpointner; Christof Schmid; Lars S Maier; Thomas Müller; Matthias Lubnow Journal: Front Med (Lausanne) Date: 2022-07-28
Authors: Olivier van Minnen; Walter M van den Bergh; Joep M Droogh; Lisette Koehorst; Wim K Lagrand; S Jorinde Raasveld; Annemieke Oude Lansink-Hartgring; Aart Terpstra; Jasper M Smit; Pieter R Tuinman; Alexander P J Vlaar Journal: Artif Organs Date: 2022-04-29 Impact factor: 2.663