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.

2nd Department of Medicine Department of Cardiovascular Medicine General University Hospital Prague Prague Czech Republic

Cardiothoracic Intensive Care National University Health System Singapore

Cardiothoracic Surgery Department of Surgery University of Utah School of Medicine Salt Lake City UT

Critical Care Research Group The Prince Charles Hospital and The University of Queensland Brisbane QLD Australia

Department of Academy for Postgraduate Medical Training Maastricht University Medical Center Maastricht The Netherlands

Department of Cardiac Surgery Heinrich Heine University Düsseldorf Germany

Department of Cardiac Surgery Vienna Medical University Vienna Austria

Department of Cardio Thoracic Surgery CARIM School for Cardiovascular Diseases Heart and Vascular Center Maastricht University Medical Center Maastricht The Netherlands

Department of Cardiology CARIM School for Cardiovascular Diseases Heart and Vascular Center Maastricht University Medical Center Maastricht The Netherlands

Department of Cardiothoracic and Vascular Anesthesia and Intensive Care AO SS Antonio e Biagio e Cesare Arrigo Alessandria Italy

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 Intensive Care Medicine and Pneumology University Hospital Regensburg Regensburg Germany

Department of Intensive Care Medicine Maastricht University Medical Center Maastricht The Netherlands

Department of Pediatric Critical Care Medicine and Child Health Evaluation and Research Center University of Michigan Ann Arbor MI

Department of School of Health Professions Education Maastricht University Maastricht The Netherlands

Department of UOC Anestesia e Rianimazione 2 Foundation IRCCS Policlinico San Matteo Pavia Italy

Department of Vascular Surgery CARIM School for Cardiovascular Diseases Heart and Vascular Center Maastricht University Medical Center Maastricht The Netherlands

Division of Pulmonary Allergy and Critical Care Medicine Columbia University Irving Medical Center and NewYork Presbyterian Hospital New York NY

ECMO Center Karolinska Department of Pediatric Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden

Emergency Medicine Department of Surgery University of Utah School of Medicine Salt Lake City UT

Crit Care Med. 2024 Jan 1;52(1):153-155. doi: 10.1097/CCM.0000000000006107. PubMed

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