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. 2024 Jan 1;52(1):80-91.
doi: 10.1097/CCM.0000000000006040. Epub 2023 Sep 5.

Bilateral Femoral Cannulation Is Associated With Reduced Severe Limb Ischemia-Related Complications Compared With Unilateral Femoral Cannulation in Adult Peripheral Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Registry

Jorik Simons  1   2   3   4   5   6   7   8   9   10   11   12   13   14   15   16   17   18   19   20   21   22 , Michele Di Mauro  1   3 , Silvia Mariani  1   3 , Justine Ravaux  1   3 , Iwan C C van der Horst  2   3 , Rob G H Driessen  1   2   3   4   5   6   7   8   9   10   11   12   13   14   15   16   17   18   19   20   21   22 , Jan Willem Sels  1   2   3   4   5   6   7   8   9   10   11   12   13   14   15   16   17   18   19   20   21   22 , Thijs Delnoij  1   2   3   4   5   6   7   8   9   10   11   12   13   14   15   16   17   18   19   20   21   22 , Daniel Brodie  5 , Darryl Abrams  5 , Thomas Mueller  6 , Fabio Silvio Taccone  7 , Mirko Belliato  8 , Mike Lars Broman  9 , Maximilian V Malfertheiner  6 , Udo Boeken  10 , John Fraser  11 , Dominik Wiedemann  12 , Jan Belohlavek  13 , Nicholas A Barrett  14 , Joseph E Tonna  15   16 , Federico Pappalardo  17 , Ryan P Barbaro  18 , Kollengode Ramanathan  19 , Graeme MacLaren  19 , Walther N K A van Mook  2   20   21 , Barend Mees  3   22 , Roberto Lorusso  1   3
Affiliations

Bilateral Femoral Cannulation Is Associated With Reduced Severe Limb Ischemia-Related Complications Compared With Unilateral Femoral Cannulation in Adult Peripheral Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Registry

Jorik Simons et al. Crit Care Med. .

Abstract

Objectives: Peripheral venoarterial extracorporeal membrane oxygenation (ECMO) with femoral access is obtained through unilateral or bilateral groin cannulation. Whether one cannulation strategy is associated with a lower risk for limb ischemia remains unknown. We aim to assess if one strategy is preferable.

Design: A retrospective cohort study based on the Extracorporeal Life Support Organization registry.

Setting: ECMO centers worldwide included in the Extracorporeal Life Support Organization registry.

Patients: All adult patients (≥ 18 yr) who received peripheral venoarterial ECMO with femoral access and were included from 2014 to 2020.

Interventions: Unilateral or bilateral femoral cannulation.

Measurements and main results: The primary outcome was the occurrence of limb ischemia defined as a composite endpoint including the need for a distal perfusion cannula (DPC) after 6 hours from implantation, compartment syndrome/fasciotomy, amputation, revascularization, and thrombectomy. Secondary endpoints included bleeding at the peripheral cannulation site, need for vessel repair, vessel repair after decannulation, and in-hospital death. Propensity score matching was performed to account for confounders. Overall, 19,093 patients underwent peripheral venoarterial ECMO through unilateral ( n = 11,965) or bilateral ( n = 7,128) femoral cannulation. Limb ischemia requiring any intervention was not different between both groups (bilateral vs unilateral: odds ratio [OR], 0.92; 95% CI, 0.82-1.02). However, there was a lower rate of compartment syndrome/fasciotomy in the bilateral group (bilateral vs unilateral: OR, 0.80; 95% CI, 0.66-0.97). Bilateral cannulation was also associated with lower odds of cannulation site bleeding (bilateral vs unilateral: OR, 0.87; 95% CI, 0.76-0.99), vessel repair (bilateral vs unilateral: OR, 0.55; 95% CI, 0.38-0.79), and in-hospital mortality (bilateral vs unilateral: OR, 0.85; 95% CI, 0.81-0.91) compared with unilateral cannulation. These findings were unchanged after propensity matching.

Conclusions: This study showed no risk reduction for overall limb ischemia-related events requiring DPC after 6 hours when comparing bilateral to unilateral femoral cannulation in peripheral venoarterial ECMO. However, bilateral cannulation was associated with a reduced risk for compartment syndrome/fasciotomy, lower rates of bleeding and vessel repair during ECMO, and lower in-hospital mortality.

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Conflict of interest statement

Drs. Brodie’s and Lorusso’s institutions received funding from LivaNova. Drs. Brodie, Broman, and Wiedemann received funding from Xenios AG (Heilbronn, Germany). Dr. Brodie received funding from Abided, Medtronic, Abiomed, Inspira, Xenios, and Cellenkos; he received research support from ALung Technologies; and he disclosed that he is President-elect of the Extracorporeal Life Support Organization (ELSO) and Chair of the Executive Committee of the International Extracorporeal Membrane Oxygenation Network. Dr. Taccone is a scientific advisor for Eurosets and Xenios. Drs. Belliato and Broman received funding from Eurosets srl (Medolla, Italy). Dr. Belliato received funding from Eswtor Spa and Hamilton Medical. Dr. Wiedemann received funding from Abbott; he is a scientific advisor for Xenios/Fresenius. Dr. Tonna’s institution received funding from the National Heart, Lung, and Blood Institute; he disclosed that he is Chair-Elect of the ELSO Registry Committee. Drs. Tonna and Barbaro received support for article research from the U.S. National Institutes of Health. Dr. Barbaro’s institution received funding from the NHBLI (R01 HL153519, R01 HD015434, and K12 HL138039); he disclosed that he is the ELSO Registry Chair. Dr. MacLaren disclosed that he serves on the Board of Directors of ELSO. Dr. Lorusso’s institution received funding from Medtronic, LivaNova, Abiomed, Getinge, and Eurosets; he disclosed that he is a member of the Medical Advisory Board for Eurosets, HemoCue, and Xenios. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

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