ECMO vascular access adverse events
Abstract:
Background: In heart transplantation (HT), peripheral veno-arterial extracorporeal membranous oxygenation (VA-ECMO) is utilized preoperatively as a direct bridge to HT or postoperatively for primary graft dysfunction. Little is known about wound complications of an arterial VA-ECMO cannulation site which can be fatal.
Methods: From 2009 to 2021, outcomes of 80 HT recipient who were supported with peripheral VA-ECMO either preoperatively or postoperatively were compared based on the site of arterial cannulation: axillary (AX: N = 49) versus femoral artery (FA: N = 31).
Results: Patients in the AX group were older (AX: 59 years vs. 52 years, P = 0.006), and less likely to have extracorporeal cardiopulmonary resuscitation (0% vs. 12.9%, P = 0.040). Survival to discharge (AX, 81.6% vs. FA. 90.3%, P = 0.460), incidence of stroke (10.2% vs. 6.5%, P = 0.863), VA-ECMO cannulation-related bleeding (6.1% vs. 12.9%, P = 0.522), and arm or limb ischemia (0% vs. 3.2%, P = 0.816) were comparable. ECMO cannulation-related wound complications were lower in the AX group (AX, 4.1% vs. FA, 45.2%, P<0.001) including the wound infections (2.0% vs. 32.3%, P<0.001). In FA group, all organisms were gram negative species. In univariate logistic regression analysis, AX cannulation was associated with less ECMO cannulation-related wound complications (Odds ratio, 0.23, P<0.001). There was no difference between cutdown and percutaneous FA insertion regarding cannulation-related complications.
Conclusions: Given the lower rate of wound complications and comparable hospital outcomes with femoral cannulation, axillary VA-ECMO may be an excellent option in HT candidates or recipients when possible.
Reference:
Ohira S, Dhand A, Hirani R, Martinez S, Lanier GM, Levine A, Pan S, Aggarwal-Gupta C, Gass AL, Wolfe K, Spielvogel D, Kai M. Cannulation-related adverse events of peripheral veno-arterial extracorporeal membrane oxygenation support in heart transplantation: Axillary versus femoral artery cannulation. Clin Transplant. 2022 Dec 5:e14871. doi: 10.1111/ctr.14871. Epub ahead of print. PMID: 36468757.