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Intensive Care Medicine

, Volume 44, Issue 12, pp 2153–2161 | Cite as

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

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

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.

Keywords

ECMO ECLS Surgical cannulation Percutaneous cannulation Adverse events 

Notes

Compliance with ethical standards

Conflicts of interest

Pr. Combes reports receiving grant support and lecture fees from Maquet and Baxter and consulting fees from Hemoven. The other authors declare that they have no conflict of interest.

Supplementary material

134_2018_5442_MOESM1_ESM.docx (422 kb)
Supplementary material 1 (DOCX 423 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Pichoy Danial
    • 1
  • David Hajage
    • 2
  • Lee S. Nguyen
    • 1
  • Ciro Mastroianni
    • 1
  • Pierre Demondion
    • 1
  • Matthieu Schmidt
    • 3
  • Adrien Bouglé
    • 4
  • Julien Amour
    • 4
  • Pascal Leprince
    • 1
  • Alain Combes
    • 3
  • Guillaume Lebreton
    • 1
  1. 1.Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP)Sorbonne UniversityParisFrance
  2. 2.Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique Et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi)ParisFrance
  3. 3.Medical Intensive Care Unit, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP)Sorbonne UniversitéParisFrance
  4. 4.Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP)Sorbonne UniversitéParisFrance

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