Anne-Sophie Martin-Tuffreau1, François Bagate2,3,4, Madjid Boukantar1, Gabriel Saiydoun5, Andrea Mangiameli1, Laura Rostain1, Gauthier Mouillet1, Antonio Fiore5, Olivier Langeron6, Armand Mekontso-Dessap2,3,4, Nicolas Mongardon6,7, Thierry Folliguet5, Emmanuel Teiger1,7, Romain Gallet8,9. 1. Service de Cardiologie, APHP, Hôpitaux Universitaires Henri Mondor, 41 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France. 2. AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010, Créteil, France. 3. Univ Paris Est Créteil, CARMAS, 94010, Créteil, France. 4. Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France. 5. Department of Cardiac Surgery, APHP, Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France. 6. Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France. 7. U955-IMRB, Equipe 03, Inserm, Univ Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire D'Alfort (EnVA), 94700, Maisons-Alfort, France. 8. Service de Cardiologie, APHP, Hôpitaux Universitaires Henri Mondor, 41 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France. romain.gallet@aphp.fr. 9. U955-IMRB, Equipe 03, Inserm, Univ Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire D'Alfort (EnVA), 94700, Maisons-Alfort, France. romain.gallet@aphp.fr.
Abstract
BACKGROUND: The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Complete angio-guided percutaneous implantation and explantation could decrease vascular complications. We sought to describe the initial results of complete percutaneous angio-guided ECMO implantation and explantation using preclosing. METHODS: All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018-12/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under angiographic guidance. The occurrence of vascular complication was recorded. RESULTS: Among the 56 patients who underwent percutaneous VA-ECMO implantation for cardiogenic shock or refractory cardiac arrest, 41 underwent preclosing. Femoral vessel cannulation was successful in all patients and total cannulation time was 20 (10-40) min. Weaning from ECMO was possible in 22/41 patients (54%) and 12 (29%) patients were alive at day 30. Significant vascular complications occurred in 2/41 patients. Percutaneous decannulation was performed in 20 patients with 19/20 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. No patient required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO. CONCLUSION: Emergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique can be an attractive strategy in patients referred for refractory cardiogenic shock.
BACKGROUND: The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Complete angio-guided percutaneous implantation and explantation could decrease vascular complications. We sought to describe the initial results of complete percutaneous angio-guided ECMO implantation and explantation using preclosing. METHODS: All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018-12/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under angiographic guidance. The occurrence of vascular complication was recorded. RESULTS: Among the 56 patients who underwent percutaneous VA-ECMO implantation for cardiogenic shock or refractory cardiac arrest, 41 underwent preclosing. Femoral vessel cannulation was successful in all patients and total cannulation time was 20 (10-40) min. Weaning from ECMO was possible in 22/41 patients (54%) and 12 (29%) patients were alive at day 30. Significant vascular complications occurred in 2/41 patients. Percutaneous decannulation was performed in 20 patients with 19/20 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. No patient required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO. CONCLUSION: Emergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique can be an attractive strategy in patients referred for refractory cardiogenic shock.
Authors: Clemens Scherer; Christopher Stremmel; Enzo Lüsebrink; Thomas J Stocker; Konstantin Stark; Carmen Schönegger; Antonia Kellnar; Jan Kleeberger; Maja Hanuna; Tobias Petzold; Sven Peterss; Daniel Braun; Jörg Hausleiter; Christian Hagl; Steffen Massberg; Martin Orban Journal: J Interv Cardiol Date: 2022-03-18 Impact factor: 2.279