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

Ranney, David N.; Benrashid, Ehsan; Meza, James M.; Keenan, Jeffrey E.; Bonadonna, Desiree; Bartz, Raquel R.; Milano, Carmelo A.; Hartwig, Matthew G.; Haney, John C.; Schroder, Jacob N.; Daneshmand, Mani A.

doi:10.1053/j.semtcvs.2017.02.007

Cited by 46 publications

(31 citation statements)

References 10 publications

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“…Tunneling the Dacron® graft from the aorta through the subxiphoid area allows the chest to be closed and subsequent ECMO weaning and discontinuation without reoperative sternotomy. 20 For arterial inflow we mostly use a Fem-Flex II arterial cannula (18)(19)(20)(21)(22) (18)(19)(20)(21)(22) was used for arterial cannulation. In some cases, pECMO cannulation was performed by cut down of the femoral vessels.…”

Section: Ecmo Implantation: Device and Cannulation Strategy Anticoagmentioning

confidence: 99%

“…15 However, bleeding at the cannula site is reported to be more common after central cannulation, causing a higher incidence of chest reexploration due to bleeding. 18 In patients without open-chest management, the necessity of reopening the chest for discontinuation of ECMO represents another disadvantage of central cannulation, not only because of an increased incidence of mediastinitis. 15,19 In patients with graft dysfunction early after htx, choice of ECMO cannulation as well as timing of implantation and device management often differ even within one transplantation center not to mention the variety between different centers.…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation after Heart Transplantation: Impact of Type of Cannulation

Mehdiani

Immohr

Boettger

et al. 2020

Thorac Cardiovasc Surg

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Background Primary graft dysfunction (PGD) is a common cause of early death after heart transplantation (htx). The use of extracorporeal life support (ECLS) after htx has increased during the last years. It is still discussed controversially whether peripheral cannulation is favorable compared to central cannulation. We aimed to compare both cannulation techniques. Methods Ninety patients underwent htx in our department between 2010 and 2017. Twenty-five patients were treated with ECLS due to PGD (10 central extracorporeal membrane oxygenator [cECMO] and 15 peripheral extracorporeal membrane oxygenator [pECMO] cannulation). Pre- and intraoperative parameters were comparable between both groups. Results Thirty-day mortality was comparable between the ECLS-groups (cECMO: 30%; pECMO: 40%, p = 0.691). Survival at 1 year (n = 18) was 40 and 30.8% for cECMO and pECMO, respectively. The incidence of postoperative renal failure, stroke, limb ischemia, and infection was comparable between both groups. We also did not find significant differences in duration of mechanical ventilation, intensive care unit stay, or in-hospital stay. The incidence of bleeding complications was also similar (cECMO: 60%; pECMO: 67%). Potential differences in support duration in pECMO group (10.4 ± 9.3 vs. 5.7 ± 4.7 days, p = 0.110) did not reach statistical significance. Conclusions In patients supported for PGD, peripheral and central cannulation strategies are safe and feasible for prolonged venoarterial ECMO support. There was no increase in bleeding after central implantation. With regard to the potential complications of a pECMO, we think that aortic cannulation with tunneling of the cannula and closure of the chest could be a good option in patients with PGD after htx.

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Section: Ecmo Implantation: Device and Cannulation Strategy Anticoagmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation after Heart Transplantation: Impact of Type of Cannulation

Mehdiani

Immohr

Boettger

et al. 2020

Thorac Cardiovasc Surg

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“…Central cannulation and right axillary cannulation are more physiologically sound than retrograde cannulation, providing more natural and effective perfusion to the whole body (18). Central cannulation does run the risk of mediastinal bleeding, often requiring exploration to be resolved (28). In contrast, peripheral cannulation has been shown to cause retrograde perfusion and conflicting flow, limiting tissue recovery (26).…”

Section: Central Vs Peripheral Cannulationmentioning

confidence: 99%

Outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: systematic review and meta-analysis

Wilson-Smith¹,

Bogdanova²,

Roydhouse³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Despite advances in management techniques and medical therapy, refractory cardiogenic shock remains a life-threatening condition with high mortality rates. The present systematic review and meta-analysis aims to explore the outcomes associated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) use in the setting of refractory cardiogenic shock, stratified per survivorship. Methods: A literature search was performed using three electronic databases from the date of their inception up to June 2018. The literature search and subsequent data extraction were performed by two independent reviewers. Digitized survival data were extracted from Kaplan-Meier curves in order to recreate the original patient data using an iterative algorithm and were subsequently aggregated for analysis. Results: Fifty-two studies were included, with 44 undergoing quantitative analysis. A total of 17,515 patients were identified, with a mean age of 58.4±9.4 years and a mean duration of ECMO support of 5.1±2.6 days; 68.7% of the patients were male. Aggregated survival rates at 1, 2, 3 and 5 years were 36.7%, 34.8%, 33.8% and 29.9%, respectively. Conclusions: The present systematic review illustrates the expected survival results for VA-ECMO in the intermediate-to long-term. Extended follow-up and standardized reporting measures are urgently needed in order to carry out more definitive subgroup analyses.

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“…In postcardiac surgery, VA‐ECMO is generally favored over VV‐ECMO as it provides hemodynamic stability but beyond that, there is no clear guidance about ECMO initiation technique including cannulation site (central vs peripheral) and timing for initiating ECMO therapy 4 . Factors relating to initiation techniques are generally dependant on patient factors, logistical factors, benefit vs risk analysis, and the preference of the clinician performing the procedure 6,8,9 . There has been no literature looking at the timing for initiation of ECMO, whilst in terms of comparison of cannulation site, a retrospective study that compared outcomes following central cannulation and peripheral cannulation reported no significant difference in mortality 10 .…”

Section: Types Of Ecmo and Indicationmentioning

confidence: 99%

The use of extracorporeal membrane oxygenation postcardiotomy—A systematic review

2020

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Objectives The use of extracorporeal membrane oxygenation (ECMO) in cardiac surgery has been established in cases of postcardiotomy cardiogenic shock, which is refractory to conventional therapy with inotropes and intra‐aortic balloon pulsation support. We sought to examine the literature in a systematic review manner on the outcomes of using ECMO postcardiac surgery. Methods A comprehensive electronic literature search was done to identify all the articles that have discussed the use of ECMO postcardiac surgery. The keywords and medical subject headings terms were used to identify the relevant articles. Studies have been screened according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Results The identified studies have been summarized in each relevant section of this study. Cardiogenic shock postcardiac surgery can benefit from ECMO to varying degrees and the survival for this; otherwise, fatal condition has been shown to be improving through the use of ECMO. However, the decision and timing to initiate ECMO therapy remains selective and is dependent on a range of factors such as patient factor, clinician's judgment, meaning there is no consistent and solid ground regarding the timing of ECMO initiation. Conclusion Current evidence suggests that the circulatory support provided by ECMO improves survival rates for postcardiac surgery cardiogenic shock patients who are refractory to inotropic management, without such ECMO support patient mortality rates would be much greater.

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

Cited by 46 publications

References 10 publications

Extracorporeal Membrane Oxygenation after Heart Transplantation: Impact of Type of Cannulation

Extracorporeal Membrane Oxygenation after Heart Transplantation: Impact of Type of Cannulation

Outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: systematic review and meta-analysis

The use of extracorporeal membrane oxygenation postcardiotomy—A systematic review

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