• Jorik Simons, Michele Di Mauro, Silvia Mariani, Justine Ravaux, van der HorstIwan C CICCDepartment of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands., Rob G H Driessen, Jan Willem Sels, Thijs Delnoij, Daniel Brodie, Darryl Abrams, Thomas Mueller, Fabio Silvio Taccone, Mirko Belliato, Mike Lars Broman, Maximilian V Malfertheiner, Udo Boeken, John Fraser, Dominik Wiedemann, Jan Belohlavek, Nicholas A Barrett, Joseph E Tonna, Federico Pappalardo, Ryan P Barbaro, Kollengode Ramanathan, Graeme MacLaren, van MookWalther N K AWNKADepartment of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.Department of School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.Department of Academ, Barend Mees, and Roberto Lorusso.
• Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands.
• Crit. Care Med. 2024 Jan 1; 52 (1): 809180-91.

ObjectivesPeripheral 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.DesignA retrospective cohort study based on the Extracorporeal Life Support Organization registry.SettingECMO centers worldwide included in the Extracorporeal Life Support Organization registry.PatientsAll adult patients (≥ 18 yr) who received peripheral venoarterial ECMO with femoral access and were included from 2014 to 2020.InterventionsUnilateral or bilateral femoral cannulation.Measurements And Main ResultsThe 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.ConclusionsThis 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.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

28 keywords...

hide…