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. 2021 Aug 26:10:322-330.
doi: 10.1016/j.xjtc.2021.08.030. eCollection 2021 Dec.

Preclosure technique versus arterial cutdown after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation

Abhimanyu Chandel  1 , Mehul Desai  2 , Liam P Ryan  3 , Lindsay Clevenger  2 , Alan M Speir  3 , Ramesh Singh  3
Affiliations

Preclosure technique versus arterial cutdown after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation

Abhimanyu Chandel et al. JTCVS Tech. .

Abstract

Background: Arteriotomy repair through the preclosure technique during elective arterial access procedures is well documented. Outcomes associated with application of this technique to the removal of arterial access cannulas in patients undergoing urgent venoarterial extracorporeal membrane oxygenation (VA-ECMO) have not previously been reported.

Methods: We reviewed the records of consecutive patients who required VA-ECMO for cardiogenic shock. Patients were compared by use of the preclosure device (Perclose ProGlide Suture-Mediated Closure System; Abbott Vascular, Abbott Park, Ill) at time of VA-ECMO cannulation. The rate of limb complications (composite of limb ischemia, infection, and site necrosis) and secondary end points of bleeding events, pseudoaneurysm, distal part embolization, and intensive care unit length of stay after decannulation were compared between the groups.

Results: Ninety-nine consecutive patients managed with VA-ECMO were identified and the preclosure device was utilized in 51 of these patients. Preclosure device failure occurred in 5 instances (9.8%) and was successfully managed with surgical repair in 4 cases and endovascular intervention in another. Use of the preclosure device was associated with both fewer limb complications (odds ratio, 0.19; 95% confidence interval, 0.03-0.78) and bleeding events (odds ratio, 0.21; 95% confidence interval, 0.04-0.89). Pseudoaneurysm (n = 0) and distal part embolization (n = 1) were infrequently encountered in the cohort and no difference in intensive care unit length of stay after decannulation was noted between the groups.

Conclusions: In this cohort, use of the preclosure technique in weaning from VA-ECMO was technically feasible, safe, and associated with an approximate 80% lower likelihood of limb complications and bleeding events compared with surgical removal.

Keywords: ICU, intensive care unit; VA-ECMO, venoarterial extracorporeal membrane oxygenation; arterial complications; arteriotomy repair; cardiogenic shock; extracorporeal membrane oxygenation; percutaneous arterial closure.

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Figures

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Graphical abstract
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Preclosure technique for VA-ECMO via the Perclose ProGlide suture-mediated closure system.
Figure 1
Figure 1
Summary of patient selection for the preclosure technique at our institution during the study period. VA-ECMO, Venoarterial extracorporeal membrane oxygenation.
Figure 2
Figure 2
A totally percutaneous approach of cannulation and decannulation from venoarterial extracorporeal membrane oxygenation (VA-ECMO) utilizing a preclosure technique was technically feasible, safe, and associated with improved vascular outcomes. ICU, Intensive care unit.
Video 1
Video 1
Dr Ramesh Singh, Surgical Director of Mechanical Circulatory Support at the Inova Heart and Vascular Institute, discussing the results and clinical implications of a totally percutaneous approach of cannulation and decannulation from VA-ECMO utilizing a preclosure technique. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00589-7/fulltext.
See this image and copyright information in PMC

References

    1. Rao P., Khalpey Z., Smith R., Burkhoff D., Kociol R.D. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail. 2018;11:e004905. - PubMed
    1. Danial P., Hajage D., Nguyen L.S., Mastroianni C., Demondion P., Schmidt M., et al. Percutaneous versus surgical femoro-femoral veno-arterial ECMO: a propensity score matched study. Intensive Care Med. 2018;44:2153–2161. - PubMed
    1. Aziz F., Brehm C.E., El-Banyosy A., Han D.C., Atnip R.G., Reed A.B. Arterial complications in patients undergoing extracorporeal membrane oxygenation via femoral cannulation. Ann Vasc Surg. 2014;28:178–183. - PubMed
    1. Au S.Y., Chan K.S., Fong K.M., Leung P.R., Ng W.G., So S.O., et al. One-year experience of bedside percutaneous VA-ECMO decannulation in a high-ECMO-volume center in Hong Kong. Perfusion. 2020;267659120971998 - PubMed
    1. Lusebrink E., Stremmel C., Stark K., Lüsebrink E., Stremmel C., Stark K., et al. Percutaneous decannulation instead of surgical removal for weaning after venoarterial extracorporeal membrane oxygenation—a crossed Perclose ProGlide closure device technique using a hemostasis valve Y connector. Crit Care Explor. 2019;1:e0018. - PMC - PubMed

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