The Role of Different Cannulation Strategies for Postcardiotomy Extracorporeal Membrane Oxygenation on Patients’ Outcome

Background: The use of postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) is constantly increasing. The impact of different cannulation strategies on morbidity, weaning success and survival is not well investigated though. Therefore, we evaluated the clinical outcomes of patients supported by different central or peripheral VA-ECMO configurations.

Method: We identified 380 patients in our institutional database who required VA-ECMO support after cardiac surgery. Peripheral VA-ECMO support was established either via peripheral cannulation of the common femoral artery (72 patients) or the subclavian artery (113 patients). Central VA-ECMO therapy was established through a direct aortic cannulation (50 patients) or via a subxiphoid-directed vascular prosthesis connected with the ascending aorta (145 patients).

Results: Demographic data and cardiac index procedures of the different groups were comparable. The duration of ECMO support did not differ significantly between the groups. Central ECMO configurations were associated with a significantly lower stroke rate (p = 0.017) compared with peripheral ECMO support. Central ECMO cannulation with a vascular prosthesis showed a significantly higher rate of bleeding complications than the other cannulation sites. ECMO weaning rates and in-hospital survival did not differ between the groups.

Conclusion: The different ECMO configurations had no influence on ECMO weaning rates and survival. Central VA-ECMO therapy was associated with as significantly lower stroke rate, but the risk of bleeding complications was significantly higher if ECMO support was established through central cannulation via a vascular prosthesis.

Publikationsverlauf

Artikel online veröffentlicht:
28. Januar 2023