Vascular complications in adult postcardiotomy cardiogenic shock patients receiving venoarterial extracorporeal membrane oxygenation

Abstract

Background: The rate, prognostic impacts, and predisposing factors of major vascular complications (MVCs) in patients underwent venoarterial extracorporeal membrane oxygenation (VA-ECMO) by surgical cut-down are poorly understood. The purpose of this study was to identify these parameters in adult VA-ECMO patients.

Methods: Adult postcardiotomy cardiogenic shock (PCS) patients receiving VA-ECMO by femoral surgical cut-down cannulation from January 2004 to December 2015 were enrolled in this study. Patients were separated into two groups depending on the presence of MVCs. Multivariate logistic regression was performed to identify factors independently associated with MVCs.

Results: Of 432 patients with PCS treated with VA-ECMO, 252 patients (58.3%) were weaned off VA-ECMO and 153 patients (35.4%) survived to discharge. MVCs were seen in 72 patients (16.7%), including bleeding or hematoma in the cannulation site (8.6%), limb ischemia requiring fasciotomy (8.6%), femoral artery embolism (0.7%), and retroperitoneal bleeding (0.7%). The rate of survival to discharge was 16.7 and 39.2% in patients with or without MVCs, respectively (p < 0.001). Obesity, concomitant with intra-aortic balloon pump (IABP), Sequential Organ Failure Assessment (SOFA) score at 24 h post-ECMO, and hemostasis disorder were shown to be associated with MVCs. MVCs were an independent risk factor for in-hospital mortality by multivariate analysis (odds ratio 3.91; 95% confidence interval, 1.67-9.14; p = 0.013).

Conclusions: MVCs are common and associated with higher in-hospital mortality among adult PCS patients receiving peripheral VA-ECMO support. The obesity, concomitant with IABP, SOFA score at 24 h post-ECMO, and hemostasis disorder were independent risk factor of MVCs.

Keywords: Cannulation; Complications; Postcardiotomy cardiogenic shock; Survival; Venoarterial extracorporeal membrane oxygenation.

Fig. 1

Study flowchart. A total of 43,192 adult patients undergoing cardiac surgery were screened. Of these patients, 432 patients who received VA-ECMO by means of femoral surgical cut-down cannulation for cardiac support were enrolled. Patients were divided into those who had or who had not had major vascular complications ([vascular complications group, n = 72] and [control group, n = 360]). Rates of in-hospital mortality, wean off VA-ECMO, and morbidity were compared

Fig. 2

Kaplan–Meier cumulative in-hospital mortality after ECMO support. Kaplan–Meier survival curves show in-hospital mortality in patients with major vascular complications (red lines) and without major vascular complications (black lines) (p < 0.001)