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Semin Thorac Cardiovasc Surg. 2017 Summer;29(2):188-195. doi: 10.1053/j.semtcvs.2017.02.007. Epub 2017 Feb 20.

Central Cannulation as a Viable Alternative to Peripheral Cannulation in Extracorporeal Membrane Oxygenation.

Author information

1
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
2
Perfusion Services, Duke University Medical Center, Durham, North Carolina.
3
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
4
Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: mani.daneshmand@duke.edu.

Abstract

Arterial cannulation for veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) is most commonly established via the aorta, axillary, or femoral vessels, yet their inherent complications are not well characterized. The purpose of this study was to compare the outcomes and complication rates of central vs peripheral cannulation. Adult patients undergoing VA ECMO between June 2009 and April 2015 were reviewed in this retrospective single-center study. Patient characteristics, clinical outcomes, and details related to deployment were extracted from the medical record. Complications and survival rates were compared between patients by cannulation strategy. Of 131 VA ECMO patients, there were 36 aortic (27.5%), 16 axillary (12.2%), and 79 femoral (60.3%) cannulations. Other than a lower mean age with femoral cannulations (53.9 ± 13.9 years) vs aortic (60.3 ± 12.2 years) and axillary (59.8 ± 12.4 years) (P = 0.032), the baseline patient characteristics were not statistically different. Central cannulation was more common in patients transferred from outside facilities (74.3% central vs 51.6% peripheral) (P = 0.053). Seven of 36 aortic cannulations were via anterior thoracotomy (19.4%). Forty of 131 patients underwent extracorporeal cardiopulmonary resuscitation (30.5%), 33 of whom were femorally cannulated. Peripheral cannulation carried a 29.5% rate of vascular complications compared with an 11.1% rate of mediastinal bleeding with central cannulation. Incidence of stroke and overall survival between groups were not statistically different. Central cannulation is a viable alternative to peripheral cannulation. Central cannulation avoids high rates of extremity morbidity without causing significant risks of alternative morbidity or death.

KEYWORDS:

ECMO; cannulation; cardiogenic shock; extracorporeal membrane oxygenation

PMID:
28823327
DOI:
10.1053/j.semtcvs.2017.02.007
[Indexed for MEDLINE]

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