STS/SCA Session: Best Practice in the Management of Postcardiotomy Low Cardiac Output State
Percutaneous Postclosure vs. Femoral Arterial Cutdown for Venoarterial Extracorporeal Membrane Cannulation Sites
Saturday, January 25, 2025
4:35pm – 4:45pm PT
Location: 409AB
T. Liu1, P. Devlin2, D. Won1, R. McGregor3, C. Mehta4, M. Medina5, B. Bryner1, D. Pham3 1Northwestern University Feinberg School of Medicine, Chicago, Illinois 2Children's Hospital of Philadelphia, Chicago, Illinois 3Northwestern Medicine, chicago, Illinois 4Northwestern University, Chicago, Illinois 5Northwestern Memorial Hospital, Chicago, Illinois
Disclosure(s):
Tom Liu, MD, MS: No financial relationships to disclose
Purpose: Percutaneous closure of large bore femoral arteriovenous extracorporeal membrane oxygenation (VA-ECMO) sites may mitigate the risks of post-operative complications associated with traditional open cut-down technique such as bleeding, wound infection, and hemodynamic instability. We examined the outcomes of percutaneous closure of VA-ECMO cannulas compared to traditional surgical cut-down technique. Methods: Between June 1, 2018 and December 31, 2023, a total of 103 unique consecutive patients underwent VA-ECMO and 89 underwent subsequent decannulation by either open cut-down (n=44) or percutaneous (n=45) suture-mediated closure. The primary outcomes of interest were procedural success, vascular complication (acute limb ischemia, diagnosis of a pseudoaneurysm, or hematoma at the site of repair) and wound site infection (superficial or deep) following decannulation. Results: Patients in both groups had similar baseline characteristics (Table). Percutaneous closure was successful in 41/45 (91.1%) of patients. Among patients undergoing isolated decannulation procedures (isolated: n=29, open: n=23), operating room time was significantly lower for percutaneously decannulated patients (75 ± 28 min vs 143 ± 45 min, p< 0.0001). Percutaneous closures were associated with reduced rates of groin infection (2.4% vs. 18.0%, p=0.04), and there was no statistical difference in the rate of vascular complications following percutaneous closure (7.3% vs. 18.8%, p=0.21). In percutaneous closure failures (n=4), 2 cannulas were inserted through the inguinal ligament, and 1 cannula involved the superficial femoral artery bifurcation requiring patch repair. All failures were in patients with BMI ≥ 35. Conclusion: Percutaneous decannulation of VA-ECMO sites can be achieved with high success rates and faster procedural time as well as lower groin infection rates when compared to traditional open closure technique. Attention to detail at the time of cannulation is essential for successful ECMO decannulation.
Identify the source of the funding for this research project: None
