Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Abstract

Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle. Results: The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively (adjusted OR 1.38, 95% CI 1.08–1.75). Propensity score matching yielded 538 pairs of patients with balanced baseline characteristics and operative variables. Among these matched cohorts, central arterial cannulation VA-ECMO was associated with significantly higher in-hospital mortality compared to peripheral arterial cannulation VA-ECMO (64.5% vs. 70.8%, p = 0.027). These findings were confirmed by aggregate data meta-analysis, which showed that central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation (OR 1.35, 95% CI 1.04–1.76, I2 21%). Conclusions: Among patients requiring postcardiotomy VA-ECMO, central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation. This increased risk is of limited magnitude, and further studies are needed to confirm the present findings and to identify the mechanisms underlying the potential beneficial effects of peripheral VA-ECMO.

A novel nomogram for predicting prolonged mechanical ventilation in lung transplantation patients using extracorporeal membrane oxygenation

“…Additionally, hemodilution, non-pulsatile perfusion and other factors can influence the microcirculation of important tissues and organs. These reasons lead to a significant increase in lactic acid concentration 23 . Severe hyperlactic acidemia decreases myocardial contractility and cardiac output, and also reduces the cardiovascular response to vasoactive drugs, further affecting tissue perfusion.…”

Serum Galectin-3 Predicts Mortality in Venoarterial Extracorporeal Membrane Oxygenation Patients

“…These results are consistent with Mahmoud U. Sani's observation [ 11 ]. Interestingly, despite peripheral arterial cannulation being the exclusive method for ECMO cannulation via the peripheral arteries, a study conducted by Fausto Biancari et al examined the cannulation methods of 1269 patients requiring postcardiotomy VA-ECMO, which found that central arterial cannulation was associated with a higher risk of in-hospital mortality compared to peripheral arterial cannulation [ 12 ]. Our ECMO team will pay attention to and collect cases with both types of cannulation in the future.…”

Risk Factors and Outcomes of Children with Congenital Heart Disease on Extracorporeal Membrane Oxygenation—A Ten-Year Single-Center Report

“…It is possible that the slightly higher survival rate (27.3% vs. 22.2%) seen in patients with central cannulation can be attributed to the use of larger cannulas and increased flow [33]. The benefits of central cannulation in post-cardiotomy adult patients are being discussed, and contrasting findings have been found in the literature [34,35]. Peripheral ECMO may have the benefit of a lesser risk of bleeding [36] but pose a risk of limb ischemia [37].…”