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Erschienen in:

14.11.2018 | Original

Percutaneous versus surgical femoro-femoral veno-arterial ECMO: a propensity score matched study

verfasst von: Pichoy Danial, David Hajage, Lee S. Nguyen, Ciro Mastroianni, Pierre Demondion, Matthieu Schmidt, Adrien Bouglé, Julien Amour, Pascal Leprince, Alain Combes, Guillaume Lebreton

Erschienen in: Intensive Care Medicine | Ausgabe 12/2018

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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.

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Ouweneel DM, Schotborgh JV, Limpens J et al (2016) Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 42:1922–1934CrossRefPubMedPubMedCentral

Combes A, Brodie D, Chen Y-S et al (2017) The ICM research agenda on extracorporeal life support. Intensive Care Med 43:1306–1318CrossRefPubMed

Combes A, Leprince P, Luyt C-E et al (2008) Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 36:1404–1411CrossRefPubMed

Pineton de Chambrun M, Bréchot N, Lebreton G et al (2016) Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest. Intensive Care Med 42:1999–2007CrossRefPubMed

Muehrcke DD, McCarthy PM, Stewart RW et al (1996) Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Ann Thorac Surg 61:684–691CrossRefPubMed

Zimpfer D, Heinisch B, Czerny M et al (2006) Late vascular complications after extracorporeal membrane oxygenation support. Ann Thorac Surg 81:892–895CrossRefPubMed

Burns S, Constantin N, Robles P, Program Investigators RECOVER (2018) Understanding the long-term sequelae of ECMO survivors. Intensive Care Med 44:1144–1147CrossRefPubMed

Ganslmeier P, Philipp A, Rupprecht L et al (2011) Percutaneous cannulation for extracorporeal life support. Thorac Cardiovasc Surg 59:103–107CrossRefPubMed

Chen YS, Ko WJ, Lin FY (2000) Insertion of percutaneous ECMO cannula. Am J Emerg Med 18:184–185CrossRefPubMed

10.

Conrad SA, Grier LR, Scott LK et al (2015) Percutaneous cannulation for extracorporeal membrane oxygenation by intensivists: a retrospective single-institution case series. Crit Care Med 43:1010–1015CrossRefPubMed

11.

Yoshimura N, Ataka K, Nakagiri K et al (1996) A simple technique for the prevention of lower limb ischemia during femoral veno-arterial cardiopulmonary support. J Cardiovasc Surg (Torino) 37:557–559

12.

Benassi F, Vezzani A, Vignali L, Gherli T (2014) Ultrasound guided femoral cannulation and percutaneous perfusion of the distal limb for VA ECMO. J Card Surg 29:427–429CrossRefPubMed

13.

Ruggeri L, Evangelista M, Consolo F et al (2017) Peripheral VA-ECMO venous cannulation: which side for the femoral cannula? Intensive Care Med 43:468–469CrossRefPubMed

14.

Dewey RC, Bradley WA, Fink LI, Goldberg D (2004) FemoStop system for arterial puncture site closure. J Invasive Cardiol 16:A16PubMed

15.

Austin PC (2011) Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 10:150–161CrossRefPubMed

16.

Austin PC (2011) An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivariate Behav Res 46:399–424CrossRefPubMedPubMedCentral

17.

Austin PC, Small DS (2014) The use of bootstrapping when using propensity-score matching without replacement: a simulation study. Stat Med 33:4306–4319CrossRefPubMedPubMedCentral

18.

Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 211:232–238CrossRefPubMed

19.

Brass P, Hellmich M, Kolodziej L et al (2015) Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev 1:CD006962PubMed

20.

Voicu S, Henry P, Malissin I et al (2018) Improving cannulation time for extracorporeal life support in refractory cardiac arrest of presumed cardiac cause - Comparison of two percutaneous cannulation techniques in the catheterization laboratory in a center without on-site cardiovascular surgery. Resuscitation 122:69–75CrossRefPubMed

21.

Bunge JJH, Mahtab EAF, Caliskan K, Reis Miranda D (2018) Fast confirmation of correct position of distal perfusion cannula during venoarterial extracorporeal membrane oxygenation. Intensive Care Med 44:658–660CrossRefPubMedPubMedCentral

22.

Takayama H, Landes E, Truby L et al (2015) Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 149:1428–1433CrossRefPubMed

23.

Rastan AJ, Dege A, Mohr M et al (2010) Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg 139(302–311):311.e1

24.

Wang J, Han J, Jia Y et al (2009) Early and intermediate results of rescue extracorporeal membrane oxygenation in adult cardiogenic shock. Ann Thorac Surg 88:1897–1903CrossRefPubMed

25.

Muller G, Flecher E, Lebreton G et al (2016) The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med 42:370–378CrossRefPubMed

26.

Lamb KM, DiMuzio PJ, Johnson A et al (2017) Arterial protocol including prophylactic distal perfusion catheter decreases limb ischemia complications in patients undergoing extracorporeal membrane oxygenation. J Vasc Surg 65:1074–1079CrossRefPubMed

27.

Foley PJ, Morris RJ, Woo EY et al (2010) Limb ischemia during femoral cannulation for cardiopulmonary support. J Vasc Surg 52:850–853CrossRefPubMed

28.

Wong JK, Smith TN, Pitcher HT et al (2012) Cerebral and lower limb near-infrared spectroscopy in adults on extracorporeal membrane oxygenation. Artif Organs 36:659–667CrossRefPubMed

29.

Steffen RJ, Sale S, Anandamurthy B et al (2014) Using near-infrared spectroscopy to monitor lower extremities in patients on venoarterial extracorporeal membrane oxygenation. Ann Thorac Surg 98:1853–1854CrossRefPubMed

30.

Hwang J-W, Yang JH, Sung K et al (2016) Percutaneous removal using Perclose ProGlide closure devices versus surgical removal for weaning after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation. J Vasc Surg 63:998–1003.e1CrossRefPubMed

31.

Majunke N, Mangner N, Linke A et al (2016) Comparison of percutaneous closure versus surgical femoral cutdown for decannulation of large-sized arterial and venous access sites in adults after successful weaning of veno-arterial extracorporeal membrane oxygenation. J Invasive Cardiol 28:415–419PubMed

32.

Burket JS, Bartlett RH, Vander Hyde K, Chenoweth CE (1999) Nosocomial infections in adult patients undergoing extracorporeal membrane oxygenation. Clin Infect Dis 28:828–833CrossRefPubMed

33.

Dangers L, Bréchot N, Schmidt M et al (2017) Extracorporeal membrane oxygenation for acute decompensated heart failure. Crit Care Med 45:1359–1366CrossRefPubMed

34.

Cakici M, Ozcinar E, Baran C et al (2017) A retrospective cohort analysis of percutaneous versus side-graft perfusion techniques for veno-arterial extracorporeal membrane oxygenation in patients with refractory cardiogenic shock. Perfusion 32:363–371CrossRefPubMed

35.

Barbaro RP, Odetola FO, Kidwell KM et al (2015) Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med 191:894–901CrossRefPubMedPubMedCentral

36.

Abrams D, Garan AR, Abdelbary A et al (2018) Position paper for the organization of ECMO programs for cardiac failure in adults. Intensive Care Med 44:717–729CrossRefPubMed

37.

Guilló Moreno V, Gutiérrez Martínez A, Romero Berrocal A et al (2018) Experience in the management of ECMO therapy as a mortality risk factor. Rev Esp Anestesiol Reanim 65:90–95CrossRef

38.

Schmidt M, Bréchot N, Hariri S et al (2012) Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis 55:1633–1641CrossRefPubMedPubMedCentral

39.

Grasselli G, Scaravilli V, Di Bella S et al (2017) Nosocomial infections during extracorporeal membrane oxygenation: incidence, etiology, and impact on patients’ outcome. Crit Care Med 45:1726–1733CrossRefPubMed

Titel: Percutaneous versus surgical femoro-femoral veno-arterial ECMO: a propensity score matched study
verfasst von: Pichoy Danial
David Hajage
Lee S. Nguyen
Ciro Mastroianni
Pierre Demondion
Matthieu Schmidt
Adrien Bouglé
Julien Amour
Pascal Leprince
Alain Combes
Guillaume Lebreton
Publikationsdatum: 14.11.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 12/2018
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5442-z

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Percutaneous versus surgical femoro-femoral veno-arterial ECMO: a propensity score matched study