Simons, Jorik and Di Mauro, Michele and Mariani, Silvia and Ravaux, Justine and van der Horst, Iwan C. C. and Driessen, Rob G. H. and Sels, Jan Willem and Delnoij, Thijs and Brodie, Daniel and Abrams, Darryl and Mueller, Thomas and Taccone, Fabio Silvio and Belliato, Mirko and Broman, Mike Lars and Malfertheiner, Maximilian V. and Boeken, Udo and Fraser, John and Wiedemann, Dominik and Belohlavek, Jan and Barrett, Nicholas A. and Tonna, Joseph E. and Pappalardo, Federico and Barbaro, Ryan P. and Ramanathan, Kollengode and Maclaren, Graeme and van Mook, Walther N. K. A. and Mees, Barend and Lorusso, Roberto (2024) 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. CRITICAL CARE MEDICINE, 52 (1). pp. 80-91. ISSN 0090-3493, 1530-0293
Full text not available from this repository.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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | VASCULAR COMPLICATIONS; MULTIPLE IMPUTATION; METAANALYSIS; MORTALITY; compartment syndrome; critical limb ischemia; extracorporeal membrane oxygenation; fasciotomy; ischemia |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 07 Aug 2025 04:53 |
| Last Modified: | 07 Aug 2025 04:53 |
| URI: | https://pred.uni-regensburg.de/id/eprint/65671 |
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