Comparison of Success Rate and Complications of Totally Percutaneous Decannulation in Patients With Veno-Arterial Extracorporeal Membrane Oxygenation and Endovascular Aneurysm Repair

Liu, Zhenjie; Xu, Yongshan; Xu, Xin; He, Minzhi; Han, Pan; Shao, Changming; Pan, Yuchen; Zhang, Libin; Yin, Li; Li, Zhenhua; Huang, Man; Chen, Bing

doi:10.3389/fmed.2021.724427

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…In particular, our study resulted in a technical success rate and only one minor bleeding that can be treated with compression. The overall complication rate was 11.1%, consistent with previous studies using the pre-closure technique of 4.8%−28.6% [14][15] .…”

Section: Discussionsupporting

confidence: 89%

“…Compared with the surgical approach, applying the percutaneous approach, usually the pre-close technique, for access closure has been reported to decrease the morbidity of the procedure, minimize the need for compression, address patient complaints, and shorten the bed-rest period in planned procedures, including EVAR and TAVI [9-10,12−13] . The standard Proglide-assisted pre-closure technique has also been popularly proposed and applied to VA-ECMO decannulation [14][15][16] . However, this technique may not be feasible in each VA-ECMO, as it is often used in emergent situations, including cardiac arrest or cardiogenic shock.…”

Section: Discussionmentioning

confidence: 99%

“…Three operators were recommended to nish the procedure: one performing the percutaneous closure, another performing bedside ultrasound, and a third for controlling bleeding. Notably, a large-bore sheath (12)(13)(14)(15)(16) was prepared for standby insertion to control the bleeding from the access site in case of closure failure during the procedure. Before the commencement of the procedure, the administration of heparin infusion was stopped, and a short monitoring period was necessary to ensure stable hemodynamics.…”

Section: Procedures Detailsmentioning

confidence: 99%

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Modified Percutaneous Post-closure Technique for Bedside Weaning of Veno-arterial Extracorporeal Membrane Oxygenation

Xu,

Cao

et al. 2024

Preprint

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Objectives This study aimed to assess the safety and efficacy of a modified percutaneous post-closure technique for bedside arterial cannula removal of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Materials: Between December 2022 and August 2023, the data of all VA-ECMO patients weaned at our center were retrospectively reviewed. A modified post-closure technique with two ProGlide devices (Abbott Vascular, Santa Clara, CA) was adopted as a routine practice. The success of the technique was defined as achieving immediate hemostasis without a bailout open repair. The post-procedural complications included bleeding events, pseudoaneurysm, limb ischemia, distal embolization, and infection at the access site. Results Overall, nine patients were included in this study. The mean age was 69.7 ± 12.9 years with a male-to-female ratio of 2:1. The mean arterial sheath size was 16.7 ± 1.3 Fr. The mean duration of the procedure was 10.9 ± 2.2 min, and the mean length of stay in the intensive care unit after weaning was 16.2 ± 4.5 days. The efficacy of the technique achieved a success rate of 100%. A single patient (11.1%) developed minor bleeding, successfully managed with compression, and no more problems were observed following the procedure. Conclusions A modified post-closure technique was a feasible and safe strategy for VA-ECMO bedside weaning and may be considered an alternative option.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Procedures Detailsmentioning

confidence: 99%

See 1 more Smart Citation

Modified Percutaneous Post-closure Technique for Bedside Weaning of Veno-arterial Extracorporeal Membrane Oxygenation

Xu,

Cao

et al. 2024

Preprint

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“…In comparison, the ProGlide device’s technical success has been reported to be 84.0%–95.8%. 10 –13 The single VCD failure in our study was likely caused by weakened vessels due to prolonged ECMO duration and indwelling of cannulas (25 days). Angio-Seal used for limb perfusion arteriotomy closure in the superficial femoral artery failed similarly (type 4 VCD failure), 2 supporting the theory.…”

Section: Discussionmentioning

confidence: 83%

Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device

et al. 2023

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Background: Peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is viable for fast hemodynamic assistance during cardiogenic shock. Ultrasound-guided closure with a large-bore device (MANTA®) is a feasible option potentially replacing surgical arteriotomy closure in peripheral VA-ECMO decannulation. Methods: This retrospective study included patients weaning from percutaneously inserted femoro-femoral VA-ECMO at the Helsinki University Hospital, Finland in 2012–2020. The primary endpoints were access-site complications, a composite of hematomas/seromas/surgical site infections (SSIs), and the safety endpoint of vascular complications (VCs). Results: A total of 100 consecutive percutaneously implanted and weaned VA-ECMO patients were stratified into two groups by decannulation strategy: percutaneous ultrasound-guided MANTA device ( n = 21, 21.0%) or surgical approach ( n = 79, 79.0%). The mean age of the cohort was 51 ± 13 years and females represented 25.0%. The technical success rate of the percutaneous ultrasound-guided MANTA technique was 95.2%. In multivariate analysis, surgical closure was associated with a higher incidence of combined access site hematomas/seromas/SSIs compared to percutaneous ultrasound-guided deployment of MANTA device (44.3% versus 9.5%, odds ratio (OR): 7.162, 95% confidence interval (CI): 1.544–33.222; p = 0.012). Similarly, access-site complications necessitating interventions were more frequent in the surgical closure group compared to US-MANTA (ultrasound-guided MANTA) group (26.6% versus 0.0%, p = 0.005). VCs were infrequent in both groups without any significant intergroup difference ( p > 0.99). Conclusions: Percutaneous ultrasound-guided MANTA closure of the femoral artery after VA-ECMO decannulation was associated with high technical success rate and low incidence of VCs. Compared to surgical closure, access-site complications were significantly less frequent, along with access-site complications necessitating interventions.

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“…Hemodynamic parameters were monitored to assess tolerance of flow reduction. Patients who tolerated minimal VA-ECMO flows and had reasonable residual RV function were decannulated from VA-ECMO via the percutaneous vascular access closure technique using Perclose ProGlide (Abbott Vascular, Santa Clara, CA, USA) (15).…”

Section: Va-ecmo Weaningmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation—First Strategy for Acute Life-Threatening Pulmonary Embolism

Liu

Chen

et al. 2022

Front. Cardiovasc. Med.

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BackgroundBoth venoarterial extracorporeal membrane oxygenation (VA-ECMO) and percutaneous mechanical thrombectomy (PMT) are increasingly used to treat acute life-threatening pulmonary embolism (PE). However, there are little data regarding their effectiveness. This study aimed to present the short-term outcomes after managing nine patients with acute life-threatening massive or submassive PE by VA-ECMO with or without complemented PMT and propose a preliminary treatment algorithm.MethodsThis study was a single-center retrospective review of a prospectively maintained registry. It included nine consecutive patients with massive or submassive pulmonary embolism who underwent VA-ECMO for initial hemodynamic stabilization, with or without PMT, from August 2018 to November 2021.ResultsMean patient age was 54.7 years. Four of nine patients (44.4%) required cardiopulmonary resuscitation before or during VA-ECMO cannulation. All cannulations (100%) were successfully performed percutaneously. Overall survival was 88.9% (8 of 9 patients). One patient died from a hemorrhagic stroke. Of the survivors, the median ECMO duration was 8 days in patients treated with ECMO alone and 4 days in those treated with EMCO and PMT. Five of nine patients (55.6%) required concomitant PMT to address persistent right heart dysfunction, with the remaining survivors (44.4%) receiving VA-ECMO and anticoagulation alone. For survivors receiving VA-ECMO plus PMT, median hospital lengths of stay were 7 and 13 days, respectively.ConclusionsAn ECMO-first strategy complemented with PMT can be performed effectively and safely for acute life-threatening massive or submassive PE. VA-ECMO is feasible for initial stabilization, serving as a bridge to therapy primarily in inoperable patients with massive PE. Further evaluation in a larger cohort of patients is warranted to assess whether VA-ECMO plus PMT may offer an alternative or complementary therapy to thrombolysis or surgical thrombectomy.Type of ResearchSingle-center retrospective review of a prospectively maintained registry.

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Comparison of Success Rate and Complications of Totally Percutaneous Decannulation in Patients With Veno-Arterial Extracorporeal Membrane Oxygenation and Endovascular Aneurysm Repair

Cited by 5 publications

References 27 publications

Modified Percutaneous Post-closure Technique for Bedside Weaning of Veno-arterial Extracorporeal Membrane Oxygenation

Modified Percutaneous Post-closure Technique for Bedside Weaning of Veno-arterial Extracorporeal Membrane Oxygenation

Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device

Extracorporeal Membrane Oxygenation—First Strategy for Acute Life-Threatening Pulmonary Embolism

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