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Bilateral Femoral Cannulation Is Associated With Reduced Severe Limb Ischemia-Related Complications Compared With Unilateral Femoral Cannulation in Adult Peripheral Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Registry
J. Simons, M. Di Mauro, S. Mariani, J. Ravaux, ICC. van der Horst, RGH. Driessen, JW. Sels, T. Delnoij, D. Brodie, D. Abrams, T. Mueller, FS. Taccone, M. Belliato, ML. Broman, MV. Malfertheiner, U. Boeken, J. Fraser, D. Wiedemann, J. Belohlavek,...
Critical care medicine.
2024 ;
52 (1) :
80-91.
[pub] 20230905
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články
Perzistentní odkaz
https://www.medvik.cz/link/bmc24000155
- MeSH
- arteria femoralis MeSH
- dospělí MeSH
- ischemie etiologie MeSH
- kompartment syndrom * MeSH
- lidé MeSH
- mimotělní membránová oxygenace * metody MeSH
- mortalita v nemocnicích MeSH
- periferní katetrizace * metody MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: Peripheral venoarterial extracorporeal membrane oxygenation (ECMO) with femoral access is obtained through unilateral or bilateral groin cannulation. Whether one cannulation strategy is associated with a lower risk for limb ischemia remains unknown. We aim to assess if one strategy is preferable. DESIGN: A retrospective cohort study based on the Extracorporeal Life Support Organization registry. SETTING: ECMO centers worldwide included in the Extracorporeal Life Support Organization registry. PATIENTS: All adult patients (≥ 18 yr) who received peripheral venoarterial ECMO with femoral access and were included from 2014 to 2020. INTERVENTIONS: Unilateral or bilateral femoral cannulation. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the occurrence of limb ischemia defined as a composite endpoint including the need for a distal perfusion cannula (DPC) after 6 hours from implantation, compartment syndrome/fasciotomy, amputation, revascularization, and thrombectomy. Secondary endpoints included bleeding at the peripheral cannulation site, need for vessel repair, vessel repair after decannulation, and in-hospital death. Propensity score matching was performed to account for confounders. Overall, 19,093 patients underwent peripheral venoarterial ECMO through unilateral ( n = 11,965) or bilateral ( n = 7,128) femoral cannulation. Limb ischemia requiring any intervention was not different between both groups (bilateral vs unilateral: odds ratio [OR], 0.92; 95% CI, 0.82-1.02). However, there was a lower rate of compartment syndrome/fasciotomy in the bilateral group (bilateral vs unilateral: OR, 0.80; 95% CI, 0.66-0.97). Bilateral cannulation was also associated with lower odds of cannulation site bleeding (bilateral vs unilateral: OR, 0.87; 95% CI, 0.76-0.99), vessel repair (bilateral vs unilateral: OR, 0.55; 95% CI, 0.38-0.79), and in-hospital mortality (bilateral vs unilateral: OR, 0.85; 95% CI, 0.81-0.91) compared with unilateral cannulation. These findings were unchanged after propensity matching. CONCLUSIONS: This study showed no risk reduction for overall limb ischemia-related events requiring DPC after 6 hours when comparing bilateral to unilateral femoral cannulation in peripheral venoarterial ECMO. However, bilateral cannulation was associated with a reduced risk for compartment syndrome/fasciotomy, lower rates of bleeding and vessel repair during ECMO, and lower in-hospital mortality.
Cardiothoracic Intensive Care National University Health System Singapore
Cardiothoracic Surgery Department of Surgery University of Utah School of Medicine Salt Lake City UT
Department of Cardiac Surgery Heinrich Heine University Düsseldorf Germany
Department of Cardiac Surgery Vienna Medical University Vienna Austria
Department of Cardiovascular Research Institute Maastricht Maastricht The Netherlands
Department of Critical Care Guy's and St Thomas' NHS Foundation Trust London United Kingdom
Department of Intensive Care Hopital Erasme Université Libre de Bruxelles Brussels Belgium
Department of UOC Anestesia e Rianimazione 2 Foundation IRCCS Policlinico San Matteo Pavia Italy
Emergency Medicine Department of Surgery University of Utah School of Medicine Salt Lake City UT
Citace poskytuje Crossref.org
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- $a Simons, Jorik $u Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands $u Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands $u Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands $u Department of Cardiology, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands $u Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY $u Department of Intensive Care Medicine and Pneumology, University Hospital Regensburg, Regensburg, Germany $u Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium $u Department of UOC Anestesia e Rianimazione 2, Foundation IRCCS Policlinico San Matteo, Pavia, Italy $u ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden $u Department of Cardiac Surgery, Heinrich-Heine-University, Düsseldorf, Germany $u Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, QLD, Australia $u Department of Cardiac Surgery, Vienna Medical University, Vienna, Austria $u 2nd Department of Medicine-Department of Cardiovascular Medicine, General University Hospital in Prague, Prague, Czech Republic $u Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom $u Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT $u Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT $u Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy $u Department of Pediatric Critical Care Medicine and Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI $u Cardiothoracic Intensive Care, National University Health System, Singapore $u Department of School of Health Professions Education, Maastricht University, Maastricht, The Netherlands $u Department of Academy for Postgraduate Medical Training, Maastricht University Medical Center, Maastricht, The Netherlands $u Department of Vascular Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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- $a Bilateral Femoral Cannulation Is Associated With Reduced Severe Limb Ischemia-Related Complications Compared With Unilateral Femoral Cannulation in Adult Peripheral Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Registry / $c J. Simons, M. Di Mauro, S. Mariani, J. Ravaux, ICC. van der Horst, RGH. Driessen, JW. Sels, T. Delnoij, D. Brodie, D. Abrams, T. Mueller, FS. Taccone, M. Belliato, ML. Broman, MV. Malfertheiner, U. Boeken, J. Fraser, D. Wiedemann, J. Belohlavek, NA. Barrett, JE. Tonna, F. Pappalardo, RP. Barbaro, K. Ramanathan, G. MacLaren, WNKA. van Mook, B. Mees, R. Lorusso
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- $a OBJECTIVES: Peripheral venoarterial extracorporeal membrane oxygenation (ECMO) with femoral access is obtained through unilateral or bilateral groin cannulation. Whether one cannulation strategy is associated with a lower risk for limb ischemia remains unknown. We aim to assess if one strategy is preferable. DESIGN: A retrospective cohort study based on the Extracorporeal Life Support Organization registry. SETTING: ECMO centers worldwide included in the Extracorporeal Life Support Organization registry. PATIENTS: All adult patients (≥ 18 yr) who received peripheral venoarterial ECMO with femoral access and were included from 2014 to 2020. INTERVENTIONS: Unilateral or bilateral femoral cannulation. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the occurrence of limb ischemia defined as a composite endpoint including the need for a distal perfusion cannula (DPC) after 6 hours from implantation, compartment syndrome/fasciotomy, amputation, revascularization, and thrombectomy. Secondary endpoints included bleeding at the peripheral cannulation site, need for vessel repair, vessel repair after decannulation, and in-hospital death. Propensity score matching was performed to account for confounders. Overall, 19,093 patients underwent peripheral venoarterial ECMO through unilateral ( n = 11,965) or bilateral ( n = 7,128) femoral cannulation. Limb ischemia requiring any intervention was not different between both groups (bilateral vs unilateral: odds ratio [OR], 0.92; 95% CI, 0.82-1.02). However, there was a lower rate of compartment syndrome/fasciotomy in the bilateral group (bilateral vs unilateral: OR, 0.80; 95% CI, 0.66-0.97). Bilateral cannulation was also associated with lower odds of cannulation site bleeding (bilateral vs unilateral: OR, 0.87; 95% CI, 0.76-0.99), vessel repair (bilateral vs unilateral: OR, 0.55; 95% CI, 0.38-0.79), and in-hospital mortality (bilateral vs unilateral: OR, 0.85; 95% CI, 0.81-0.91) compared with unilateral cannulation. These findings were unchanged after propensity matching. CONCLUSIONS: This study showed no risk reduction for overall limb ischemia-related events requiring DPC after 6 hours when comparing bilateral to unilateral femoral cannulation in peripheral venoarterial ECMO. However, bilateral cannulation was associated with a reduced risk for compartment syndrome/fasciotomy, lower rates of bleeding and vessel repair during ECMO, and lower in-hospital mortality.
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