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

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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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Authors and Affiliations

  1. Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l’hopital, Paris, 75013, France

    Pichoy Danial, Lee S. Nguyen, Ciro Mastroianni, Pierre Demondion, Pascal Leprince & Guillaume Lebreton

  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), CIC-1421, Paris, France

    David Hajage

  3. Medical Intensive Care Unit, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France

    Matthieu Schmidt & Alain Combes

  4. Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France

    Adrien Bouglé & Julien Amour

Authors
  1. Pichoy Danial
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  2. David Hajage
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  3. Lee S. Nguyen
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  11. Guillaume Lebreton
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Correspondence to Guillaume Lebreton.

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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.

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Danial, P., Hajage, D., Nguyen, L.S. et al. Percutaneous versus surgical femoro-femoral veno-arterial ECMO: a propensity score matched study. Intensive Care Med 44, 2153–2161 (2018). https://doi.org/10.1007/s00134-018-5442-z

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  • DOI: https://doi.org/10.1007/s00134-018-5442-z

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